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Sample records for acetabular hip system

  1. Osteoarthritis of the hip and acetabular dysplasia.

    Croft, P.; Cooper, C.; Wickham, C; Coggon, D

    1991-01-01

    The relation between acetabular dysplasia and osteoarthritis of the hip was examined in a series of 1516 pelvic radiographs taken for non-skeletal indications. Osteoarthritis was assessed by measuring joint space, and dysplasia by the centre-edge angle and acetabular depth. In contrast with previous studies of patients with symptomatic osteoarthritis of the hip, no evidence that dysplasia predisposes to osteoarthritis was found. Possible reasons for the discrepancy are discussed. It was concl...

  2. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    2010-04-01

    ... prosthesis. 888.3370 Section 888.3370 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND... (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip) acetabular metal cemented prosthesis is a device intended to be implanted to replace a portion of the hip...

  3. Comparison of acetabular reamings during hip resurfacing versus uncemented total hip arthroplasty.

    Brennan, S A

    2009-04-01

    PURPOSE: To compare the quantity of bone removed from the acetabulum during resurfacing hip arthroplasty versus uncemented total hip arthroplasty (THA). METHODS: 62 consecutive patients with osteoarthritis of the hip were prospectively studied. 24 men and 7 women aged 40 to 86 (mean, 59) years underwent Birmingham hip resurfacing. 13 men and 18 women aged 34 to 88 (mean, 61) years underwent uncemented THA using the trident acetabular cup. Obese elderly women at risk of femoral neck fracture and patients with large subchondral pseudocysts or a history of avascular necrosis of the femoral head were assigned to uncemented THA. Acetabular reamings were collected; marginal osteophytes were not included. The reamings were dehydrated, defatted, and weighed. RESULTS: The mean weight of acetabular reamings was not significantly different between patients undergoing hip resurfacing and uncemented THA (p=0.57). CONCLUSION: In hip resurfacing, the use of an appropriately small femoral component avoids oversizing the acetabular component and removal of excessive bone stock.

  4. MRI morphometric hip comparison analysis of anterior acetabular labral tears

    Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip. Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed. Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7 , 95 % confidence interval [CI]: 56.2-69.2 ) compared with the AALTs group (46.9 , 95 % CI: 40.1-53.7 ). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9 , 95 % CI: 39.3 -44.5 ) compared to AALTs group (29.4 , 95 % CI: 24.2 -34.6 ). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group. Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI. (orig.)

  5. MRI morphometric hip comparison analysis of anterior acetabular labral tears

    Aly, Abdel Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Saskatoon City Hospital, Saskatoon, SK (Canada); Rajasekaran, Sathish [HealthPointe, Pain, Spine and Sport Medicine, Alberta (Canada); Obaid, Haron [Royal University Hospital, University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2013-09-15

    Anterior (3 o'clock) acetabular labral tears (AALTs) have been reported to be associated with iliopsoas impingement (IPI). However, no study has examined the association between anatomical bony variables of the hip joint and AALTs. The purpose of this study was to evaluate the association between AALTs, femoroacetabular impingement (FAI) and other bony variables of the hip. Seventy-six out of 274 hip MRI records met the inclusion criteria. Two independent blinded investigators evaluated the location of acetabular labral tears (ALTs), edema at the musculotendinous junction of the iliopsoas insertion, femoral neck anteversion angle, femoral neck shaft angle, acetabular anteversion angle, alpha angle, lateral central edge angle (LCEA), acetabular index, and acetabular depth. Comparison analyses between groups were performed. Twenty-two patients had no ALTs (controls), 19 patients had AALTs, and 35 patients had ALTs not isolated at the 3 o'clock position (25 with cam-bony deformities [FAI-cam] and 10 with pincer-bony deformities [FAI-pincer]). The alpha angle mean was significantly higher (p < 0.001) in the FAI-cam group (62.7 , 95 % confidence interval [CI]: 56.2-69.2 ) compared with the AALTs group (46.9 , 95 % CI: 40.1-53.7 ). The LCEA mean was significantly higher (p < 0.001) in FAI-pincer group (41.9 , 95 % CI: 39.3 -44.5 ) compared to AALTs group (29.4 , 95 % CI: 24.2 -34.6 ). There was no statistically significant difference in any of the bony variables between the controls and the AALTs group. Our study demonstrated that AALTs are pathologically distinct and not associated with FAI or other bony abnormalities. This supports the previous studies, which proposed that AALTs are associated with IPI. (orig.)

  6. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients ...

  7. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

    Tian, Chun-Yan [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Wang, Jian-Quan [Department of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191,PR China (China); Zheng, Zhuo-Zhao, E-mail: zzhuozhao@aliyun.com [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Ren, A.-Hong [Department of Radiology, Beijing Daxing Hospital, 26 West Huangcun Road, Daxing District, Beijing 102600 (China)

    2014-10-15

    Highlights: • MR is the preferred imaging modality for diagnosing acetabular labral tears. • The diagnostic performance of MR arthrography are superior than conventional hip MR. • The hip MR arthrography is recommended for diagnosing acetabular labral lesions. - Abstract: Objective: To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears. Methods: 90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy. Results: 59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05). Conclusion: Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.

  8. Cemented total hip arthroplasty with impacted morcellized bone-grafts to restore acetabular bone defects in congenital hip dysplasia.

    Bolder, S.B.T.; Melenhorst, J.; Gardeniers, J.W.M.; Slooff, T.J.J.H.; Veth, R.P.H.; Schreurs, B.W.

    2001-01-01

    We evaluated the results of 27 acetabular reconstructions in 21 patients with secondary osteoarthritis resulting from congenital dysplasia of the hip in which the acetabular bone defects were restored with impacted morcellized bone-grafts in combination with a cemented cup. At an average follow-up o

  9. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I;

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  10. Cranial acetabular retroversion is common in developmental dysplasia of the hip as assessed by the weight bearing position

    Troelsen, Anders; Mikkelsen, Lone Rømer; Jacobsen, Steffen;

    2010-01-01

    The appearance of acetabular version differs between the supine and weight bearing positions in developmental dysplasia of the hip. Weight bearing radiographic evaluation has been recommended to ensure the best coherence between symptoms, functional appearance, and hip deformities. Previous...... prevalence estimates of acetabular retroversion in dysplastic hips have been established in radiographs recorded with the patient supine and with inclusion only if pelvic tilt met standardized criteria. We assessed the prevalence and the extent of acetabular retroversion in dysplastic hip joints in weight...

  11. The Effect of an Acetabular Labral Tear, Repair, Resection, and Reconstruction on the Hip Fluid Seal

    Nepple, Jeffrey J.; Campbell, Kevin J.; Wijdicks, Coen A.; Jansson, Kyle; Dornan, Grant; LaPrade, Robert F.; Philippon, Marc J.

    2014-01-01

    Objectives: The acetabular labrum is theorized to have an important role in the normal function of the hip through the hip fluid seal. The hip fluid seal functions to create intra-articular fluid pressurization and stability to distractive forces. Yet, the effect of a labral tear or partial labral resection, and interventions including labral repair and labral reconstruction, on the hip fluid seal remain to be defined. The purpose of the current study was to characterize the hip fluid seal, i...

  12. Femoro-acetabular impingement and hip pain with conventionally normal x-rays.

    Baker, J F

    2010-06-01

    There has in recent years been a fundamental change in the understanding of hip pain in the young adult and hip pain without plain radiographic findings of arthritis. Pain in these groups has long represented a diagnostic and therapeutic challenge. With new appreciation of hip biomechanics, pathological processes and the arrival of modern imaging modalities we now have a greater understanding of non-arthritic hip pathology. One of the commonest yet least well recognized \\'new\\' diagnoses around the hip is femoro-acetabular impingement (FAI). FAI is a developmental condition of the hip joint that is associated with abnormal anatomical configuration and thus joint mechanics on either the femoral or acetabular sides or both. It is hypothesized to have a variety of precipitants and may ultimately lead to labral and chondral injury and what has previously been referred to as \\'primary\\' or \\'idiopathic\\' hip osteoarthritis.

  13. Entrapment of the acetabular labrum following reduction of traumatic hip dislocation in a child

    In traumatic hip dislocation, concentric reduction can be prevented by various causes. Soft-tissue interposition, such as entrapment of the acetabular labrum, is a rare but important cause of failed reduction of a hip. Early diagnosis of incomplete reduction due to interposition of soft tissue is important, because delayed treatment is associated with a greater incidence of avascular necrosis of the femoral head and early onset of osteoarthritis. This report describes a case of acetabular labral entrapment following reduction of traumatic hip dislocation in a child. The importance of CT and MRI in arriving at an early diagnosis is emphasized. (orig.)

  14. A novel classification to guide total hip arthroplasty for adult acetabular dysplasia

    Zhu, Chen; CHENG, MENG-QI; Cheng, Tao; MA, RUI-XIANG; Kong, Rong; GUO, YONG-YUAN; Qin, Hui; SHI, SI FENG; Zhang, Xian-long

    2013-01-01

    In the field of hip arthroplasties, the secondary fixation of the implants depends directly on the quality of the primary stability. A good acetabular fit and metaphyseal filling between the prostheses and implants improve the initial stabilization, and optimize the transmission of forces to the bone. A precise knowledge of the three-dimensional acetabular or femoral shape is essential to the selection of adapted implants. A total of 63 patients diagnosed with developmental dysplasia were ana...

  15. Numerical modelling of the pelvis and acetabular construct following hip arthroplasty

    Phillips, Andrew T. M.

    2005-01-01

    The study presents finite element models of the acetabular construct and the pelvis. Particular attention is given to investigating the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. Mechanical tests are carried out on bone graft, and constitutive models are developed to describe its non-linear elasto-plastic behaviour, for inclusion in finite element analyses. Impaction of bone graft was found to have...

  16. The significance of evaluating the craniolateral acetabular rim for hip dysplasia

    The weight-bearing part of the canine hip is its dorsocraniolateral portion. On the radiograph the configuration of the craniolateral acetabular rim is important for evaluation of hip dysplasia. Changes in formation of this area should be differentiated from artefacts due to malpositioning. When the pelvis is tilted dorsally, the cranial acetabular rim is superimposed on the cranioventral acetabular contour and the acetabular roof. The craniolateral contour then seems to be missing. The contours of a ventrally tilted pelvis do not overlap, but it is difficult to discern the craniolateral rim. The reference points for Norberg-Olsson's measurements are difficult to choose in both cases and the angles may vary up to 10 degrees. A symmetrically positioned pelvis shows one point of reference for Norberg-Olsson's measurement where the cranial acetabular contour, the cranioventral margin and the acetabular roof intersect. Therefore poor positioning of the pelvis for radiographic evaluation of hip dysplasia should be avoided when using Norberg-Olsson's measurements

  17. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    2010-04-01

    ... cemented acetabular component, prosthesis. 888.3320 Section 888.3320 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  18. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    2010-04-01

    ... uncemented acetabular component, prosthesis. 888.3330 Section 888.3330 Food and Drugs FOOD AND DRUG..., prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis is a two-part device intended to be implanted to replace a hip joint. The...

  19. Osteonecrosis and femoro-acetabular impingement: sequelae of developmental dysplasia of the hip

    Cheung, Jason Pui Yin; Chow, Wang; To, Michael

    2012-01-01

    A 2-year-old girl with developmental dysplasia of the right hip underwent open reduction and capsulorrhaphy via the anterior approach with hip spica casting in an internally rotated position. During her 26 years of follow-up, she was found to have osteonecrosis and subsequently cam-type femoro-acetabular impingement at 28 years of age. She was treated with surgical dislocation of the hip and osteochondroplasty to recreate the normal contour of the head and neck offset.

  20. Delayed cementless total hip arthroplasty for neglected dislocation of hip combined with complex acetabular fracture and deficient bone stock

    Gavaskar Ashok S

    2012-12-01

    Full Text Available 【Abstract】Total hip arthroplasty (THA for an un-treated acetabular fracture is technically challenging and the long-term result is not so favorable. A 45-year-old fe-male patient with untreated column and comminuted poste-rior wall fracture of the acetabulum was treated in our insti-tution by reconstruction of the posterior wall using iliac strut autograft and plate stabilization of the posterior col-umn with cancellous grafting and cementless THA in a single stage. At 3 years’ follow-up, the patient was independently mobile without limb length discrepancy. Radiological evalu-ation showed well integrated components and bone grafts. No evidence of aseptic loosening or osteolysis was found. This report aims to emphasize that bony acetabular recon-struction allows the use of primary hip components, which improves prosthesis longevity and preserves bone stock for a future revision. Key words: Acetabulum; Fractures, bone; Hip dislocation; Arthroplasty, replacement, hip

  1. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    Ghanem, Mohamed; Glase, Almuth; Zajonz, Dirk; Roth, Andreas; Heyde, Christoph-E.; Josten, Christoph; von Salis-Soglio, Georg

    2016-01-01

    Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR) in multi-morbid patients. Patients and methods: During the period from January 1st 2007 to December 31st 2011 19 revision hip surgeries were performed in 19 patients, in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%). All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months). Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%. Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%). The most common complication encountered was the proximal migration of the bipolar head. The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%). Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as

  2. Bipolar hip arthroplasty as salvage treatment for loosening of the acetabular cup with significant bone defects

    Ghanem, Mohamed

    2016-04-01

    Full Text Available Introduction: Revision arthroplasty of the hip is becoming increasingly important in recent years. Early primary arthroplasty and longer life expectancy of the patients increases the number of revision surgery. Revision surgery of hip arthroplasty is major surgery for the patients, especially the elderly, with significant risks concerning the general condition of the patient. The aim of this work is to evaluate the outcome of bipolar hip arthroplasty as a salvage procedure for treatment of loosening of the acetabular cup with significant acetabular bone defects after total hip replacement (THR in multi-morbid patients.Patients and methods: During the period from January 1 2007 to December 31 2011 19 revision hip surgeries were performed in , in which the loosened acetabular cup was replaced by a bipolar head. The examined patient group consisted exclusively of female patients with an average of 75 years. The predominant diagnosis was “aseptic loosening” (84.2%. All patients in our study were multi-morbid. We decided to resort to bipolar hip arthroplasty due to the compromised general condition of patients and the major acetabular bone defects, which were confirmed intraoperatively. The postoperative follow-up ranged from 0.5 to 67 months (average 19.1 months. Results: Evaluation of the modified Harris Hip Score showed an overall improvement of the function of the hip joint after surgery of approximately 45%.Surgery was less time consuming and thus adequate for patients with significantly poor general health condition. We noticed different complications in a significant amount of patients (68.4%. The most common complication encountered was the proximal migration of the bipolar head.The rate of revision following the use of bipolar hip arthroplasty in revision surgery of the hip in our patients was high (21%. Despite the high number of complications reported in our study, we have noticed significant improvement of hip joint function as well

  3. Peri-acetabular bone mineral density in total hip replacement

    Gauthier, L.(University of Illinois at Chicago (UIC), Chicago, USA); Dinh, L.; Beaulé, P. E.

    2013-01-01

    Objectives To quantify and compare peri-acetabular bone mineral density (BMD) between a monoblock acetabular component using a metal-on-metal (MoM) bearing and a modular titanium shell with a polyethylene (PE) insert. The secondary outcome was to measure patient-reported clinical function. Methods A total of 50 patients (25 per group) were randomised to MoM or metal-on-polyethlene (MoP). There were 27 women (11 MoM) and 23 men (14 MoM) with a mean age of 61.6 years (47.7 to 73.2). Measurement...

  4. Ultrasound versus Magnetic Resonance Arthrography in Acetabular Labral Tear Diagnostics: A Prospective Comparison in 20 Dysplastic Hips

    Troelsen, A.; Jacobsen, S.; Bolvig, L.; Gelineck, J.; Roemer, L.; Soeballe, K. [Orthopedic Research Unit and Dept. of Radiology, Univ. Hospital of Aarhus, A arhus (Denmark)

    2007-11-15

    Background: Acetabular labral tears are highly associated with hip dysplasia. Magnetic resonance arthrography (MR arthrography) is the expensive and time-consuming contemporary gold-standard method in the radiological assessment of acetabular labral tears. Purpose: To assess the diagnostic ability of noninvasive ultrasound (US) examination compared to MR arthrography in diagnosing acetabular labral tears in dysplastic hip joints. Material and Methods: The study compared US examination and MR arthrography diagnosis of labral tears in 20 consecutively referred dysplastic hip joints. Results: The ability to diagnose acetabular labral tears upon US examination was calculated: sensitivity 44%, specificity 75%, positive predictive value 88%, and negative predictive value 25%. Conclusion: The ability of US examination in diagnosing acetabular labral tears is not yet good enough. The technique is still to be developed, and more experience, especially with the interpretation of US examinations, is needed.

  5. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

    Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

    2008-03-01

    Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

  6. Acetabular component migration in total hip arthroplasty using CT and a semiautomated program for volume merging

    Purpose: To develop a non-invasive method for detection of acetabular cup migration after total hip arthroplasty (THA) with a higher degree of accuracy than routine plain radiography. Material and Methods: Two CT examinations, 10 min apart, were obtained from each of 10 patients that had undergone THA. Using an in-house developed semiautomated program for volume merging, the pelves in the two examinations were fused and the acetabular cup was visually and numerically evaluated to test the method's accuracy in detecting migration. Results: In the visual evaluation of the best match a 1-mm translation of the cup was detectable. The numerical evaluation, comparing landmarks placed in the images of the acetabular cup and the head of the femur component in the two examinations, showed the mean difference in orientation of acetabular axes to be 2.5 deg, the mean distance between centre of cup face to be 2.5 mm and the mean distance between centre of the head of the prosthetic femoral component to be 1 mm. Conclusion: This method has a significantly higher accuracy than routine plain radiography in detecting acetabular cup migration and could be used in clinical practice. It gives both a visual and a numerical correlate to migration

  7. Relationship between developmental dislocation of the hip in infant and acetabular dysplasia at skeletal maturity.

    Okano, Kunihiko; Yamaguchi, Kazumasa; Ninomiya, Yoshikazu; Matsubayashi, Shohei; Aoyagi, Kiyoshi; Osaki, Makoto; Enomoto, Hiroshi; Takahashi, Katsuro

    2015-01-01

    Previous reports demonstrated 8-60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH.A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17-59 years).Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle.Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH. PMID:25569642

  8. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint

    Alshameeri, Zeiad; Khanduja, Vikas

    2014-01-01

    Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to rec...

  9. Hip Revision

    Full Text Available ... Revision Featuring the ZMR® Hip System Tapered Distal Stem Zimmer, Inc. Winfield, Illinois September 3, 2009 Welcome ... a hybrid hip arthroplasty with a cemented femoral stem and an acetabular shell. You can see the ...

  10. Acetabular morphometry and prevalence of hip dysplasia in the South Asian population

    Masood Umer

    2009-07-01

    Full Text Available We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints was studied. There were 136 males (54.4% and 114 females (45.6%. Mean age of our study population was 38 years (15-78 years. The average center edge angle was 35.5±6.6° standard deviation (SD, acetabular angle was 37.76±4.37°, depth to width ratio was 0.31±4.6°, roof obliquity was 10.6±6.2°, extrusion index was 0.1±5.8, lateral subluxation 8.9±2.7 mm, and peak to edge distance 17±3.98 mm. There was significant influence (p lower than  0.05 of age in all angles except depth to width ratio. A total of seven hip joints (1.4% were dysplastic with CE angle lower than 25° while four of the seven hips were severely dysplastic with CE angle  lower than 20°. In the dysplastic group there was significant correlation (p lower than 0.05 of CE angle with acetabular angle, depth to width ratio, extrusion index and peak to edge distance. Prevalence of hip dysplasia was found to be very low in our population. These results are consistent with the findings of studies carried out in other Asian countries.

  11. The role of the acetabular labrum in hip dysplasia

    Hartig-Andreasen, Charlotte; Søballe, Kjeld; Troelsen, Anders

    2013-01-01

    A periacetabular osteotomy (PAO) is the preferred joint preserving treatment for young adults with symptomatic hip dysplasia and no osteoarthritis. In symptomatic dysplasia of the hip, there is labral pathology in up to 90% of cases. However, no consensus exists as to whether a labral tear should be treated before the periacetabular osteotomy (PAO), treated simultaneously with the PAO, or left alone and only treated if symptoms persist after the PAO. This review is an update of aspects of lab...

  12. Radiographic signs of acetabular dysplasia of the adult hip

    Lingg, G.; von Torklus, D.

    1981-06-01

    Many papers have been published about the different types of measurements used in the evaluation of hip dysplasia in the pediatric age group. However, there are no publications that deal with this topic regarding adults. The authors present an initial series of measurements of the angle of the roof of the acetabulum in 100 randomized asymptomatic adult males. The normal value ranged from -10/sup 0/ to +10/sup 0/. These measurements were correlated with those described by Wiberg. The combination of both methods yields highly reliable information in the evaluation of hip dysplasia.

  13. Early catastrophic acetabular failure in Furlong total hip replacements

    Knox, David; Hamilton, Steven W.; Wardlaw, Douglas; Gibson, Peter H.

    2009-01-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision.

  14. Early catastrophic acetabular failure in Furlong total hip replacements.

    Knox, David; Hamilton, Steven W; Wardlaw, Douglas; Gibson, Peter H

    2009-03-01

    The use of uncemented hip arthroplasty prostheses with ceramic articulations are popular, especially in the young, because of a perceived reduction in wear. We highlight a complication of ceramic on polyethylene articulating couples not previously described in the Furlong replacement. Despite widespread metalosis and particulate debris, osteolysis was not initially seen. The contamination compromised subsequent revision. PMID:19384635

  15. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    Akiyama, Mio; Nakashima, Yasuharu; Fujii, Masanori; Sato, Taishi; Yamamoto, Takuaki; Mawatari, Taro; Motomura, Goro; Matsuda, Shuichi; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka (Japan)

    2012-11-15

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  16. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  17. Experimental and analytical validation of a modular acetabular prosthesis in total hip arthroplasty

    Aram Luke

    2007-05-01

    Full Text Available Abstract A finite element model has been developed to predict in vivo micro motion between a modular acetabular cup and liner after cement less total hip arthroplasty. The purpose of this study is to experimentally validate the model. Six LVDT sensors were used to monitor the micromotion of the liner when subjected to loading conditions ranging from 250 N to 5000 N. Deformations at points of interest for both the experiment and FEM were compared. Results of the FEM with different coefficient of friction between the liner and the cup were investigated to correlate with the experimental results.

  18. Rapid Hip Osteoarthritis Development in a Patient with Anterior Acetabular Cyst with Sagittal Alignment Change

    Yasuhiro Homma

    2014-01-01

    Full Text Available Rapidly destructive coxarthrosis (RDC is rare and develops unusual clinical course. Recent studies suggest multiple possible mechanisms of the development of RDC. However the exact mechanism of RDC is still not clear. The difficulty of the study on RDC is attributed to its rareness and the fact that the data before the onset of RDC is normally unavailable. In this report, we presented the patient having the radiographic data before the onset who had rapid osteoarthritis (OA development after contralateral THA, which meets the current criteria of RDC. We thought that the increased posterior tilt of the pelvis after THA reinforced the stress concentration at pre-existed anterior acetabular cyst, thereby the destruction of the cyst was occurred. As a result the rapid OA was developed. We think that there is the case of rapid osteoarthritis developing due to alternating load concentration by posterior pelvic tilt on preexisting anterior acetabular cyst such as our patient among the cases diagnosed as RDC without any identifiable etiology. The recognition of sagittal alignment changes and anterior acetabular cyst may play important role in prediction and prevention of the rapid hip osteoarthritis development similar to RDC.

  19. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction. PMID:24559522

  20. Development of Imageless Computer Navigation for Acetabular Component Position in Total Hip Replacement

    Dorr, Lawrence D.; Hishiki, Yuji; Wan, Zhinian; Newton, Deanne; Yun, Andrew

    2005-01-01

    The purpose of this study was to develop an imageless (without preoperative computerized tomography (CT) scans or intraoperative fluoroscopy) computer navigation system for total hip replacement. One-hundred and ninety-five hips were operated with imageless computer navigation. Eighty-five hips were operated prior to obtaining precise results, with precision refined in the subsequent 110 hips. Computer accuracy for cup-adjusted anteversion was achieved in 100% of the final 40 hips, and for ad...

  1. Determinación del desgaste del componente acetabular en prótesis totales de cadera. // Wear determination of acetabular component in total hip prosthesis.

    G. García del Pino

    2002-01-01

    Full Text Available En este trabajo se realiza un estudio a través del Método de los Elementos Finitos “MEF” sobre el desgaste del componenteacetabular durante el ciclo de marcha y considerando algunos casos extremos de cargas como subir y bajar escaleras,levantarse de una silla, etc. Utilizando el MEF fueron modelados independientemente los componentes acetabular yfemoral de la prótesis total de cadera y puestos en contacto posteriormente. Fueron estudiadas varias posiciones delacetábulo así como diferentes casos de carga simulando pacientes con diferente peso corporal y actividades físicas. Paraevaluar los resultados se crearon rutinas en lenguaje C que organizaron los mismos para un tratamiento estadísticoposterior.Palabras claves: biomecánica, ortopedia, elementos finitos, modelación, desgaste, prótesis de cadera.___________________________________________________________________________Abstract.A wear study of acetabular component during the marching cycle, considering some extreme loads cases as: ascend anddescend stairways, get up from a seat, etc , by means of Finite Elements Method ( FEM , is carried out. The acetabular andfemoral component of the total hip prosthesis were independently modeled and placed in contact lastly. Several acetabulpositions were studied as well as different load cases, simulating patients with different body weight and different physicalactivities. To evaluate the results routines in C language were created in order to organized the same ones for a laterstatistical treatment.Key words. biomechanics, ortophedy, finite elements, modelation, wear, hip bone prosthesis.

  2. Acetabular bone density and metal ions after metal-on-metal versus metal-on-polyethylene total hip arthroplasty; short-term results

    Zijlstra, Wierd P.; van der Veen, Hugo C.; van den Akker-Scheek, Inge; Zee, Mark J. M.; Bulstra, Sjoerd K.; van Raay, Jos J. A. M.

    2014-01-01

    Information on periprosthetic acetabular bone density is lacking for metal-on-metal total hip arthroplasties. These bearings use cobalt-chromium instead of titanium acetabular components, which could lead to stress shielding and hence periprosthetic bone loss. Cobalt and chromium ions have detriment

  3. Reliability of ultrasonographic measurements in suspected patients of developmental dysplasia of the hip and correlation with the acetabular index

    Cem Copuroglu

    2011-01-01

    Full Text Available Background: Ultrasonography is accepted as a useful imaging modality in the early detection of developmental dysplasia of the hip (DDH. Early detection and early treatment of DDH prevents hip dislocation and related physical, social, economic, and psychological problems. The purpose of this study was to evaluate the reliability of ultrasonographic and roentgenographic measurements measured by seven different observers. Materials and Methods: The alpha angles of 66 hips in 33 patients were measured using the Graf method by seven different observers. Acetabular index degrees on plane roentgenograms were measured in order to assess the correlation between the ultrasonographic alpha angle and the radiographic acetabular index, which both show the bony acetabular depth, retrospectively. Results: The interclass correlation coefficient, measuring the interobserver reliability, was high and statistically significant for the ultrasonographic measurements. There was a negative correlation between the alpha angle and the acetabular index. Conclusions: Ultrasonography, when applied properly, is a reliable technique between different observers, in the diagnosis and follow up of DDH. When assessed concomitantly with the roentgenographic measurements, the results are reliable and statistically meaningful.

  4. Evaluation of Medial Acetabular Wall Bone Stock in Patients with Developmental Dysplasia of the Hip Using a Helical Computed Tomography Multiplanar Reconstruction Technique

    Rui Yu Liu; Kun Zheng Wang; Chun Sheng Wang; Xiao Qian Dang; Zhi Qin Tong (Second Hospital Affiliated to the Medical College of Xi' an Jiaotong Univ., Xi' an Shaanxi (China))

    2009-08-15

    Background: The technique of medialization has been used to reconstruct acetabula at the level of true acetabula in total hip arthroplasty (THA) in patients with developmental dysplasia of the hip (DDH). Appreciation of the bone stock in the medial acetabular wall is significant for making an optimal acetabular reconstruction plan and avoiding complications. Purpose: To evaluate the bone stock of the medial acetabular wall and its relation to the degree of subluxation in patients with DDH using computed tomography (CT). Material and Methods: Helical CT scans of 27 hips were obtained from 21 patients with osteoarthritis secondary to DDH who were scheduled for total hip arthroplasty. Eleven hips belonged to Crowe class I, while 16 hips belonged to Crowe class II/III. The raw CT data were reprocessed in various planes by scrolling multiplanar reformation (MPR). Acetabular opening, depth, and medial bone stock, as indicated by the minimum thickness of the medial acetabular wall, were measured in the transverse reformed MPR plane. Results: The minimum thicknesses of the medial acetabular wall in Crowe-I and Crowe-II/III hips were 3.8+-2.1 mm and 7.1+-3.1 mm, respectively, with statistically significant differences between the groups (P<0.05). Furthermore, the bone stock in the medial acetabular wall correlated with the degree of subluxation (R=0.69) and the acetabular depth (R= ;- ;0.71). Conclusion: There was significantly more bone stock in the medial acetabular wall in patients with higher-degree subluxation than there was in the less-severe class. This difference should be taken into consideration when reconstructing acetabula in THA in patients with DDH using the technique of medialization

  5. Migration measurement of acetabular components in cementless total hip arthroplasty; Messung der Pfannenwanderung bei zementfreien Hueftimplantaten

    Eckardt, A.; Karbowski, A.; Schwitalle, M.; Vogel, J.; Boden, F.; Seeleitner, C. [Mainz Univ. (Germany). Orthopaedische Klinik und Poliklinik; Schunk, K. [Mainz Univ. (Germany). Klinik und Poliklinik fuer Radiologie; Mayrhofer, P. [Innsbruck Univ. (Austria). Inst. fuer Mathematik und Geometrie

    1998-08-01

    Migration measurements of acetabular components using a special computer aided method (EBRA = abbrevation for the German term ``Ein-Bild-Roentgenanalyse``) were performed to evaluate early results of the implants and predict aseptic loosening. Methods: Standard ap-radiographs of the pelvis were marked, specific points were digitised. Simulating the spatial situation the programme computes lengitudinal and vertical migration of the cup. 74 acetabular components in 71 patients could be studied by migration measurements. Results: 14 patients showed migration of more than 1 mm, which is the confidence limit of this method. Each of these patients showed diverse reasons for the migration, i.e. osteoporosis of the acetabular bone stock or problems concerning the surgical technique which means malposition of the cup or insufficient reaming of the bone. There were some patients with severe congenital dysplasia of the hip and in some cases the inclination angle of the cup was too great. Conclusion: The technique applied for measuring migration of acetabular components can be useful for evaluating early instability of the implant and can be helpful in detecting problems concerning the surgical technique. (orig.) [Deutsch] Mittels der Ein-Bild-Roentgenanalyse wurden Pfannenwanderungen nach Implantation von zementfreien, sphaerischen Hueftgelenkspfannen erfasst, um Praediktoren fuer die langfristige Prognose der Implantate zu evaluieren. Methoden: Nach Markierung von Referenzpunkten in den Beckenuebersichtsaufnahmen wurden diese digitalisiert, vom Programm verrechnet und die Wanderung des Implantats im Verlauf angegeben. Bei 71 Patienten wurden von 74 Pfannen ueber einen Mindestnachuntersuchungszeitraum von 12 Monaten Migrationsmessungen durchgefuehrt. Das Konfidenzintervall der Methode liegt bei <1 mm. Bei jedem dieser Patienten fanden sich Hinweise entweder auf ein schlechtes Knochenlager, auf operationsbedingte Probleme, wenn keine ausreichende Primaerstabilitaet der Pfanne

  6. The crescent sign: dissociation of the polyethylene liner from a modular acetabular component in total hip arthroplasty

    To study whether there was a common pattern of clinical symptoms, signs and radiographic features for the dissociation of the polyethylene liner from an acetabular component and to postulate reasons for these features. Retrospective study of notes and radiographs of cases of revision hip arthroplasty for polyethylene liner dissociation of the cementless Harris-Galante I porous-coated acetabular component (Zimmer Inc, Warsaw, IN) at the Avon Orthopaedic Centre, Bristol, UK and St. Mary's Hospital, Bristol, UK between 1995 and 2004. Patients were contacted to confirm preoperative symptoms. Nine cases of late polyethylene liner dissociation of this prosthesis have been revised in these institutions. All patients presented with a reduction in mobility, groin pain and limp. Eight patients reported an audible noise on hip movement. In all cases, radiographs showed radiolucency medial to the femoral neck in association with an eccentrically placed femoral head showing contact with the acetabular metal shell, which we have termed the ''crescent sign.'' There is a typical clinical presentation in this study. The diagnosis can be made from a single anteroposterior pelvic radiograph without the need for previous films for comparison, or the need for arthrography. Clinicians should look specifically for the crescent sign when an eccentrically placed femoral head has been noted, in order to differentiate the more unusual diagnosis of dissociation from that of polyethylene wear. Early revision surgery can prevent damage to the femoral head and metal acetabular shell, thus reducing the complexity of revision surgery. (orig.)

  7. The effect of femoro-acetabular impingement on the kinematics and kinetics of the hip joint.

    Alshameeri, Zeiad; Khanduja, Vikas

    2014-08-01

    Gait analysis is an objective tool that has been used to assess and monitor treatment for many musculoskeletal conditions. Recently, it has been used to assess the impact of femoro-acetabular impingement (FAI) on the hip and lower limb movements. There have been a fairly limited number of studies published so far reporting unexpected and inconsistent results, which calls for more research to be conducted in this arena. In the light of the limited data available, it has been challenging to reconcile the contradictions in some of these results, and therefore no coherent conclusions could be drawn. In this short article, we attempt to explain some of the abnormal kinematic and kinetic patterns associated with FAI by highlighting similarities between the gait seen in early osteoarthritis (OA) and that of FAI. We also propose an approach for future research in this field and emphasise the importance of quantifying early OA in FAI based on magnetic resonance imaging (MRI) scans and the amount of chondral damage seen during open or arthroscopic surgery. PMID:24687267

  8. Acetabular deepening in the treatment of severe canine hip dysplasia Aprofundamento do acetábulo no tratamento de displasia coxofemoral grave em cães

    Paulo Iamaguti; Luciana S. Iamaguti; Raquel Sartor

    2009-01-01

    A technique to restore acetabular anatomy by deepening the acetabular cavity and reconstructing the femoral head ligament and the joint capsule was tested on nine large breed dogs with severe hip dysplasia and acute subdislocation or dislocation. The technique consisted of two phases. First, all dogs were submitted to bilateral pectinotomy. In a second surgical intervention on the same dogs the acetabulum was approached and deepened, and the femoral head ligament and the joint capsule were re...

  9. Analysis of acetabular version in the native hip: comparison between 2D axial CT and 3D CT measurements

    Dandachli, Wael [Department of Orthopaedic Surgery, Imperial College London Hospitals, London (United Kingdom); Ul Islam, Saif; Tippett, Richard; Hall-Craggs, Margaret A.; Witt, Johan D. [University College London Hospitals, London (United Kingdom)

    2011-07-15

    To compare two-dimensional (2D) axial with three-dimensional (3D) computerized tomography (CT) measurements of acetabular version in native hips. CT scans of 34 hips in 17 consecutive patients being investigated for femoroacetabular impingement were analyzed. Acetabular version was measured using 2D CT at two different axial levels, one cranial (slice 2) and the other at the equator (slice 3). The measurements were repeated after correction for pelvic tilt. The results were compared to the measurements of anatomical version obtained using a 3D CT method that automatically corrects for pelvic tilt. The mean acetabular version using the 3D CT method was 15.7 (SD 6.9 ). The mean version using slice 2 was 9.3 (SD 6.5 ) before correction for pelvic tilt and 15.7 (SD 8.0 ) after the correction. The mean version using slice 3 was 16.4 (SD 4.2 ) before tilt correction and 19.0 (SD 5.0 ) after the correction. In relation to the 3D method, the intraclass correlation coefficient (ICC) was 0.58 for the uncorrected and 0.93 for the corrected slice 2 method. For the uncorrected and corrected slice 3 methods, the ICC was 0.64 and 0.89, respectively. The 2D axial methods produced variable results. The results that correlated best with the 3D method were those of the cranial slice (slice 2) after correction for pelvic tilt. Interpretation of 2D axial CT measurements of acetabular version should be done with caution. The level at which the measurement is done and the presence of pelvic tilt appear to be significant factors. (orig.)

  10. Two-stage total hip arthroplasty for complex pelvic abnormalities: Example of hip arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union.

    Jacquot, A; Goetzmann, T; Jullion, S; Sirveaux, F; Molé, D; Roche, O

    2016-06-01

    Hip prosthesis implantation requires a stable pelvic foundation, which may be lacking in patients with complex pelvic abnormalities (e.g., arthrodesis conversion, tumour excision, or revision with large bony defects). Many reconstructive options exist for these situations, but their outcomes vary with the initial amount of bone loss and with the technique used. We describe a two-stage arthroplasty technique (acetabular cup first, then femoral stem) and report its use in a case of arthrodesis conversion with concomitant treatment of pelvic and acetabular non-union. Clinical and radiological outcomes after 5 years are reported. This procedure can be adapted to the most complex cases of pelvic reconstruction. PMID:27052938

  11. Model Studies on Acetabular Component Migration in Total Hip Arthroplasty using CT and a Semiautomated Program for Volume Merging

    Purpose: Validation of a non-invasive CT method for detection of acetabular cup migration after total hip arthroplasty in a phantom study. Material and Methods: 26 CT examinations were obtained of a pelvic model while altering the position of the acetabular cup. Using a previously described program for volume merging, the pelvi in different examinations were fused and the 3D alterations of the position of the acetabular cup were evaluated visually and numerically and correlated to direct measurements on the model. Results: Visually, two independent examiners differentiated between 0, 1 and 2 to 3 mm migration with 100% specificity and sensitivity. Numerically, the mean error over all cases between model and CT measurements was 0.04 mm (SD ± 0.33). The mean absolute error between model and CT data was 0.26 mm (SD ± 0.19). Intra- and interobserver 95% accuracy and repeatability limits were below 0.5/0.7 mm, respectively. No significant interobserver difference occurred. The data were normally distributed and not dependent on observer. Conclusion: The accuracy of this non-invasive method out-performs routine plain radiography. The method gives both visual and numerical correlates to migration and can be used in clinical practice

  12. Computed tomography arthrography with traction in the human hip for three-dimensional reconstruction of cartilage and the acetabular labrum

    Aim: To develop and demonstrate the efficacy of a computed tomography arthrography (CTA) protocol for the hip that enables accurate three-dimensional reconstructions of cartilage and excellent visualization of the acetabular labrum. Materials and methods: Ninety-three subjects were imaged (104 scans); 68 subjects with abnormal anatomy, 11 patients after periacetabular osteotomy surgery, and 25 subjects with normal anatomy. Fifteen to 25 ml of contrast agent diluted with lidocaine was injected using a lateral oblique approach. A Hare traction splint applied traction during CT. The association between traction force and intra-articular joint space was assessed qualitatively under fluoroscopy. Cartilage geometry was reconstructed from the CTA images for 30 subjects; the maximum joint space under traction was measured. Results: Using the Hare traction splint, the intra-articular space and boundaries of cartilage could be clearly delineated throughout the joint; the acetabular labrum was also visible. Dysplastic hips required less traction (∼5 kg) than normal and retroverted hips required (>10 kg) to separate the cartilage. An increase in traction force produced a corresponding widening of the intra-articular joint space. Under traction, the maximum width of the intra-articular joint space during CT ranged from 0.98–6.7 mm (2.46 ± 1.16 mm). Conclusions: When applied to subjects with normal and abnormal hip anatomy, the CTA protocol presented yields clear delineation of the cartilage and the acetabular labrum. Use of a Hare traction splint provides a simple, cost-effective method to widen the intra-articular joint space during CT, and provides flexibility to vary the traction as required. - Highlights: • We present a hip CTA protocol to clearly delineate the intra-articular space. • A Hare traction splint provides a simple, cost-effective way to apply traction. • The required traction force depends on individual hip morphology. • The traction force

  13. Palliative surgery for acetabular metastasis with pathological central dislocation of the hip joint after radiation therapy. A case report

    Orthopedic surgery for bone metastases is mainly a palliative treatment. Pathological central dislocation of the hip joint secondary to osteonecrosis of acetabular metastasis after radiation therapy brings severe suffering to cancer patients. We performed minimally invasive palliative surgery for an elderly woman, and excellent pain relief was achieved. An 80-year-old female suffering from right hip pain was referred to our hospital. She had undergone surgery for lung cancer 5 years previously and her right acetabulum was subsequently affected by metastasis. With the aim of controlling the metastasis, radiation therapy was performed. Two years later, pathological central dislocation of the hip joint occurred with sudden onset of severe pain, and she was unable to maintain a sitting position and became bedridden. After she was referred to our hospital, we created an intentional pseudarthrosis in the femoral neck for palliation. After the surgery, excellent pain relief and remarkably improved mobility were achieved during her limited remaining lifetime. In this report, we introduce a novel method of producing a pseudarthrosis in the femoral neck for pathological dislocation. This procedure is a minimally invasive treatment and an alternative option for palliative surgery for pathological dislocation of the hip joint due to osteonecrosis after radiation therapy. (author)

  14. Acetabular retroversion as a rare cause of chronic hip pain: recognition of the ''figure-eight'' sign

    Banks, Kevin P. [Brooke Army Medical Center, Department of Radiology, Fort Sam Houston, TX (United States); Grayson, David E. [Wilford Hall Medical Center, Department of Radiology, Lackland Air Force Base, TX (United States)

    2007-06-15

    While well-recognized in the orthopedic literature as a cause of chronic hip pain, acetabular retroversion has not been specifically described in the radiologic literature. Acetabular retroversion represents a particular form of hip dysplasia characterized by abnormal posterolateral orientation of the acetabulum. This pathophysiology predisposes the individual to subsequent anterior impingement of the femoral neck upon the anterior acetabular margin and fibrous labrum. Without treatment, cases may progress to damage of the anterior labrum and cartilage, with eventual early onset of osteoarthritic disease. This impinging condition has been described as occurring in isolation or as part of a complex dysplasia. We describe two cases of acetabular retroversion diagnosed by conventional radiographic evaluation of the pelvis, one in isolation and one occurring in the setting of a larger congenital syndrome. These cases illustrate the utility of the ''figure-eight'' sign in identifying abnormalities of acetabular version and thus assisting clinicians in properly identifying these individuals so that appropriate therapy may be instituted. (orig.)

  15. A Comparison of the Contact Force Distributions on the Acetabular Surface Due to Orthopedic Treatments for Developmental Hip Dysplasia.

    Márquez-Flórez, Kalenia M; Silva, Octavio; Narváez-Tovar, Carlos A; Garzón-Alvarado, Diego A

    2016-07-01

    We used a three-dimensional rigid body spring model (RBSM) to compare the contact force distributions on the acetabular surface of the infant hip joint that are produced by three orthopedic treatments for developmental dysplasia of the hip (DDH). We analyzed treatments using a Pavlik harness, a generic rigid splint, and a spica cast. The joint geometry was modeled from tomography images of a 1-year-old female. The articular cartilage was modeled as linear springs connecting the surfaces of the acetabulum and the femoral head, whereas the femur and the hip bone were considered as rigid bodies. The hip muscles were modeled as tensile-only preloaded springs. The treatments with the Pavlik harness and the generic rigid splint were modeled for an infant in supine position with a hip flexion angle of 90 deg. Also, since rigid splints are often recommended when children are initiating their gait phase, we modeled the treatment with the infant in standing position. For the spica cast, we only considered the infant in standing position with a flexion angle of 0 deg, and the fixation bar at two heights: at the ankle and at the knee. In order to analyze the effect of the hip abduction angle over the contact force distribution, different abduction angles were used for all the treatments modeled. We have found that the treatments with the infant in supine position, with a flexion angle of 90 deg and abduction angles between 60 deg and 80 deg, produce a more homogenous contact force distribution compared to those obtained for the treatments with the infant in standing position. PMID:27150210

  16. An extended posterior approach to the hip and pelvis for complex acetabular reconstruction that preserves the gluteal muscles and their neurovascular supply.

    Solomon, L B; Hofstaetter, J G; Bolt, M J; Howie, D W

    2014-01-01

    We investigated the detailed anatomy of the gluteus maximus, gluteus medius and gluteus minimus and their neurovascular supply in 22 hips in 11 embalmed adult Caucasian human cadavers. This led to the development of a surgical technique for an extended posterior approach to the hip and pelvis that exposes the supra-acetabular ilium and preserves the glutei during revision hip surgery. Proximal to distal mobilisation of the gluteus medius from the posterior gluteal line permits exposure and mobilisation of the superior gluteal neurovascular bundle between the sciatic notch and the entrance to the gluteus medius, enabling a wider exposure of the supra-acetabular ilium. This technique was subsequently used in nine patients undergoing revision total hip replacement involving the reconstruction of nine Paprosky 3B acetabular defects, five of which had pelvic discontinuity. Intra-operative electromyography showed that the innervation of the gluteal muscles was not affected by surgery. Clinical follow-up demonstrated good hip abduction function in all patients. These results were compared with those of a matched cohort treated through a Kocher-Langenbeck approach. Our modified approach maximises the exposure of the ilium above the sciatic notch while protecting the gluteal muscles and their neurovascular bundle. PMID:24395310

  17. Three-dimensional magnetic resonance imaging analysis of hip morphology in the assessment of femoral acetabular impingement

    Kavanagh, E.C. [Department of Radiology, Mater Misericordiae Hospital, Dublin (Ireland); Read, P.; Carty, F.; Zoga, A.C. [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States); Parvizi, J. [The Rothman Institute of Orthopedics, Philadelphia, PA (United States); Morrison, W.B., E-mail: William.Morrison@Jefferson.edu [Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA (United States)

    2011-08-15

    Aim: To determine a possible association between femoral-acetabular impingement (FAI) volume and the development of labral tear using a three-dimensional (3D) model reconstruction of the acetabulum and the femoral head. Materials and methods: Magnetic resonance arthrography images of the hip in 42 patients with pain and suspected labral tear were acquired using a 1.5 T MRI machine. Using 3D analysis software, outlines of the acetabular cup and femoral head were drawn and 3D reconstruction obtained. To control for differences in patient size, ratios of acetabulum : femoral head volume (AFV) and acetabulum : femoral head surface area (AFA) were used for analysis. The association between volume of acetabulum : femoral head and FAI was investigated using ANOVA analysis. Results: There were 19 men and 23 women with a mean age of 39 years (range 18-78 years). The average AFV was 0.64 (range 0.37-1.05, SD 0.16) and AFA was 0.73 (range 0.36-1.26, SD 0.23). Herniation pit was significantly associated with a small AFV. Conclusion: Femoral neck herniation pits are associated with a low AFV. Gross volume and surface area ratios do not appear to correlate with labral tears or cartilage loss. This technique will enable more advanced analysis of morphological variations associated with FAI.

  18. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

    Needell, Steven D.; Borzykowski, Ross M. [Boca Radiology Group, Boca Raton, FL (United States); Carreira, Dominic S.; Kozy, John [Broward Health Orthopedics and Sports Medicine, Fort Lauderdale, FL (United States)

    2014-11-15

    To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115 through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography. (orig.)

  19. CT false-profile view of the hip: a reproducible method of measuring anterior acetabular coverage using volume CT data

    To devise a simple, reproducible method of using CT data to measure anterior acetabular coverage that results in values analogous to metrics derived from false-profile radiographs. Volume CT images were used to generate simulated false-profile radiographs and cross-sectional false-profile views by angling a multiplanar reformat 115 through the affected acetabulum relative to a line tangential to the posterior margin of the ischial tuberosities. The anterolateral margin of the acetabulum was localized on the CT false-profile view corresponding with the cranial opening of the acetabular roof. Anterior center edge angle (CEA) was measured between a vertical line passing through the center of the femoral head and a line connecting the center of the femoral head with the anterior edge of the condensed line of the acetabulum (sourcil). Anterior CEA values measured on CT false-profile views of 38 symptomatic hips were compared with values obtained on simulated and projection false-profile radiographs. The CT false-profile view produces a cross-sectional image in the same obliquity as false-profile radiographs. Anterior CEA measured on CT false-profile views were statistically similar to values obtained with false-profile radiographs. CT technologists quickly mastered the technique of generating this view. Inter-rater reliability indicated this method to be highly reproducible. The CT false-profile view is simple to generate and anterior CEA measurements derived from it are similar to those obtained using well-positioned false-profile radiographs. Utilization of CT to assess hip geometry enables precise control of pelvic inclination, eliminates projectional errors, and minimizes limitations of image quality inherent to radiography. (orig.)

  20. A safe zone for acetabular component position in metal-on-metal hip resurfacing arthroplasty: winner of the 2012 HAP PAUL award.

    Liu, Fei; Gross, Thomas P

    2013-08-01

    A safe zone for acetabular component positioning in hip resurfacing (RAIL: Relative Acetabular Inclination Limit) was calculated based on implant size and acetabular inclination angle (AIA). For AIA below the RAIL, there were no adverse wear failures or dislocations, and only 1% of cases with ion levels above 10 μg/L. Other than high inclination angle and small bearing size, female gender was the only other factor that correlated with high ion levels in the multivariate analysis. Seven hundred sixty-one hip resurfacing cases are included in this study. The UCLA activity score, femoral shaft angle, body mass index, weight, American Society of Anesthesiologists score, combined range of motion, diagnosis, age, gender, implant brand, AIA, bearing size, and duration of implantation were analyzed to determine the potential risk factors for elevated metal ion levels. These findings apply to sub hemispheric metal-on-metal bearings with similar coverage arcs as the Biomet and Corin hip resurfacing brands. Additional problems may occur when these bearings are connected with trunions on stems for total hip arthroplasty. PMID:23540536

  1. Assessment of Accuracy and Reliability in Acetabular Cup Placement Using an iPhone/iPad System.

    Kurosaka, Kenji; Fukunishi, Shigeo; Fukui, Tomokazu; Nishio, Shoji; Fujihara, Yuki; Okahisa, Shohei; Takeda, Yu; Daimon, Takashi; Yoshiya, Shinichi

    2016-07-01

    Implant positioning is one of the critical factors that influences postoperative outcome of total hip arthroplasty (THA). Malpositioning of the implant may lead to an increased risk of postoperative complications such as prosthetic impingement, dislocation, restricted range of motion, polyethylene wear, and loosening. In 2012, the intraoperative use of smartphone technology in THA for improved accuracy of acetabular cup placement was reported. The purpose of this study was to examine the accuracy of an iPhone/iPad-guided technique in positioning the acetabular cup in THA compared with the reference values obtained from the image-free navigation system in a cadaveric experiment. Five hips of 5 embalmed whole-body cadavers were used in the study. Seven orthopedic surgeons (4 residents and 3 senior hip surgeons) participated in the study. All of the surgeons examined each of the 5 hips 3 times. The target angle was 38°/19° for operative inclination/anteversion angles, which corresponded to radiographic inclination/anteversion angles of 40°/15°. The simultaneous assessment using the navigation system showed mean±SD radiographic alignment angles of 39.4°±2.6° and 16.4°±2.6° for inclination and anteversion, respectively. Assessment of cup positioning based on Lewinnek's safe zone criteria showed all of the procedures (n=105) achieved acceptable alignment within the safe zone. A comparison of the performances by resident and senior hip surgeons showed no significant difference between the groups (P=.74 for inclination and P=.81 for anteversion). The iPhone/iPad technique examined in this study could achieve acceptable performance in determining cup alignment in THA regardless of the surgeon's expertise. [Orthopedics. 2016; 39(4):e621-e626.]. PMID:27322169

  2. Anterior coverage after eccentric rotational acetabular osteotomy for the treatment of developmental dysplasia of the hip

    Imai, Hiroshi; Kamada, Tomomi; Takeba, Jun; Shiraishi, Yoshitaka; Mashima, Naohiko; Miura, Hiromasa

    2014-01-01

    Background In periacetabular osteotomy for the treatment of developmental dysplasia of the hip, impairments in ADL due to limitations in hip flexion can occur when anterior displacement is added to lateral displacement in order to obtain sufficient femoral head coverage. This study was conducted to determine, by the range of motion (ROM) simulation based on CT images, the minimum angle of hip flexion and internal rotation at 90° of flexion that is necessary to avoid ADL impairments after ecce...

  3. Development of a novel acetabular cup component for large bearing total hip arthroplasty

    Gillard, Faye Catherine

    2014-01-01

    Total hip replacement (THR) is a successful procedure that demonstrates excellent long term survival rates in the elderly patient population. Resurfacing and large diameter bearing total hip components were introduced to improve survivorship in younger patients but problems associated with high levels of wear and component loosening has limited their acceptance in regular clinical practice. Aurora Medical Ltd (Southampton, UK) identified a need for a large diameter bearing hip replacement whi...

  4. The role of the acetabular labrum in hip dysplasia. A literature overview

    Hartig-Andreasen, Charlotte; Søballe, Kjeld; Troelsen, Anders

    2013-01-01

    A periacetabular osteotomy (PAO) is the preferred joint preserving treatment for young adults with symptomatic hip dysplasia and no osteoarthritis. In symptomatic dysplasia of the hip, there is labral pathology in up to 90% of cases. However, no consensus exists as to whether a labral tear should...... be treated before the periacetabular osteotomy (PAO), treated simultaneously with the PAO, or left alone and only treated if symptoms persist after the PAO. This review is an update of aspects of labral anatomy and function, the etiology of labral tears in hip dysplasia, and diagnostic assessment of...... labral tears, and we discuss treatment strategies for coexisting labral tears and hip dysplasia....

  5. No red cell alloimmunization or change of clinical outcome after using fresh frozen cancellous allograft bone for acetabular reconstruction in revision hip arthroplasty: a follow up study

    Mittag Falk

    2012-09-01

    Full Text Available Abstract Background Possible immunization to blood group or other antigens and subsequent inhibition of remodeling or incorporation after use of untreated human bone allograft was described previously. This study presents the immunological, clinical and radiological results of 30 patients with acetabular revisions using fresh frozen non-irradiated bone allograft. Methods AB0-incompatible (donor-recipient bone transplantation was performed in 22 cases, Rh(D incompatible transplantation in 6 cases. The mean follow up of 23 months included measuring Harris hip score and radiological examination with evaluation of remodeling of the bone graft, implant migration and heterotopic ossification. In addition, all patients were screened for alloimmunization to Rh blood group antigens. Results Compared to the whole study group, there were no differences in clinical or radiological measurements for the groups with AB0- or Rh(D-incompatible bone transplantation. The mean Harris Hip Score was 80.6. X-rays confirmed total remodeling of all allografts with no acetabular loosening. At follow up, blood tests revealed no alloimmunization to Rh blood group donor antigens. Conclusions The use of fresh frozen non-irradiated bone allograft in acetabular revision is a reliable supplement to reconstruction. The risk of alloimmunization to donor-blood group antigens after AB0- or Rh-incompatible allograft transplantation with a negative long-term influence on bone-remodeling or the clinical outcome is negligible.

  6. The results of a press-fit-only technique for acetabular fixation in hip dysplasia.

    Takao, Masaki; Nakamura, Nobuo; Ohzono, Kenji; Sakai, Takashi; Nishii, Takashi; Sugano, Nobuhiko

    2011-06-01

    The purpose of the present study was to evaluate the 6- to 11-year follow-up results of hemispherical porous-coated cups implanted into dysplastic hips using press-fit technique without screws focusing on the amount of host bone coverage. There were 87 patients who underwent 98 primary total hip arthroplasties. Bony coverage was measured as the angle between the vertical line and the line drawn from the cup center to the lateral edge of the acetabulum, which was named the cup center-edge angle (cup-CE angle). All 98 cups were judged to be bone ingrown. The minimum cup-CE angle was 8.4° (mean, 26.3°). Bone-cup contact of more than 8.4° of the cup-CE angle was large enough for press-fit cups to resist superior directed loads during this follow-up period. PMID:20647158

  7. Determinación del desgaste del componente acetabular en prótesis totales de cadera. // Wear determination of acetabular component in total hip prosthesis.

    G. García del Pino; Gonçalves, E; R. Gonzáles Lima; R. Dantas Queiroz; J. L. Valín Rivera

    2002-01-01

    En este trabajo se realiza un estudio a través del Método de los Elementos Finitos “MEF” sobre el desgaste del componenteacetabular durante el ciclo de marcha y considerando algunos casos extremos de cargas como subir y bajar escaleras,levantarse de una silla, etc. Utilizando el MEF fueron modelados independientemente los componentes acetabular yfemoral de la prótesis total de cadera y puestos en contacto posteriormente. Fueron estudiadas varias posiciones delacetábulo así como diferentes cas...

  8. Automatic measurement system for congenital hip dislocation using a computed radiography

    Acetabular angle which is a diagnostic parameter of congenital hip dislocation has been measured manually in conventional X-ray film system. Using digital image directly provided from a computed radiography, an automatic measurement system was developed for this parameter. The process of the measurement was completed within a reasonable time, and accurate enough. The system was combined with an image database, so that it would be a measurement tool of PACS

  9. Hip Ultrasound

    ... Infant ultrasound can be used to check the hips for developmental dysplasia of the hip (DDH), which in infants can range from a shallow cup (bony acetabular dysplasia), to complete dislocation with the ball of the ...

  10. Acetabular deepening in the treatment of severe canine hip dysplasia Aprofundamento do acetábulo no tratamento de displasia coxofemoral grave em cães

    Paulo Iamaguti

    2009-02-01

    Full Text Available A technique to restore acetabular anatomy by deepening the acetabular cavity and reconstructing the femoral head ligament and the joint capsule was tested on nine large breed dogs with severe hip dysplasia and acute subdislocation or dislocation. The technique consisted of two phases. First, all dogs were submitted to bilateral pectinotomy. In a second surgical intervention on the same dogs the acetabulum was approached and deepened, and the femoral head ligament and the joint capsule were reconstructed. In general, within 30 days of the surgery dogs could stand on the operated member to walk. Except for two dogs, all the others recovered pelvic member locomotive ability within 60-90 days after surgery. It is concluded that acetabuloplasty is a good alternative for treatment of severe canine hip dysplasia.Uma técnica para restituir a anatomia acetabular com aprofundamento da cavidade acetabular e reconstrução do ligamento da cabeça do fêmur e da cápsula articular, foi testada em nove cães, de raças de grande porte, portadores de displasia coxofemoral grave com subluxação acentuada ou luxação. O procedimento cirúrgico foi constituído de duas fases. Inicialmente, foi realizada a pectineotomia bilateral em todos os cães. A segunda intervenção nos mesmos cães incluiu abordagem e aprofundamento do acetábulo, reconstrução do ligamento da cabeça do fêmur e da cápsula. Em geral, 30 dias após a cirurgia, os cães apoiavam o membro operado para se locomover. Com exceção de dois cães, todos os outros recuperaram a função locomotora do membro pélvico dentro de 60-90 dias. É concluído que a técnica de acetabuloplastia é uma boa alternativa para o tratamento da displasia coxofemoral grave.

  11. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  12. A novel technique for impaction bone grafting in acetabular reconstruction of revision total hip arthroplasty using an ex vivo compaction device

    Impaction bone grafting allows restoration of the acetabular bone stock in revision hip arthroplasty. The success of this technique depends largely on achieving adequate initial stability of the component. To obtain well-compacted, well-graded allograft aggregates, we developed an ex vivo compaction device to apply it in revision total hip arthroplasty on the acetabular side, and characterized mechanical properties and putative osteoconductivity of allograft aggregates. Morselized allograft bone chips were compacted ex vivo using the creep technique and subsequent impaction technique to form the bone aggregates. Impaction allograft reconstruction of the acetabulum using an ex vivo compaction device was performed on eight hips. The mechanical properties and three-dimensional micro-CT-based structural characteristics of the bone aggregates were investigated. In clinical practice, this technique offered good reproducibility in reconstructing the cavity and the segmental defects of the acetabulum, with no migration and no loosening of the component. In vitro analysis showed that the aggregates generated from 25 g fresh-frozen bone chips gained compression stiffness of 13.5-15.4 MPa under uniaxial consolidation strain. The recoil of the aggregates after compaction was 2.6-3.9%. The compression stiffness and the recoil did not differ significantly from those measured using a variety of proportions of large- and small-sized bone chips. Micro-CT-based structural analysis revealed average pore sizes of 268-299 μm and average throat diameter of pores in the bone aggregates of more than 100 μm. These sizes are desirable for osteoconduction, although large interconnected pores of more than 500 μm were detectable in association with the proportion of large-sized bone chips. Cement penetration into the aggregates was related to the proportion of large-sized bone chips. This study introduces the value of an ex vivo compaction device in bone graft compaction in clinical

  13. Validation of a simple radiographic method to determine variations in pelvic and acetabular cup sagittal plane alignment after total hip arthroplasty

    Shon, Won Yong; Hur, Chang Yong; Jajodia, Nirmal [Korea University College of Medicine, Guro Hospital, Department of Orthopedics, Seoul (Korea); Gupta, Siddhartha; Biswal, Sandeep; Hong, Suk Joo; Myung, Jae Sung [Korea University College of Medicine, Guro Hospital, Department of Radiology, Seoul (Korea)

    2008-12-15

    Orientation of acetabular component, influenced by pelvic tilt, body position, and individual variations affects the outcome following total hip arthroplasty (THA). Currently available methods of evaluation are either imprecise or require advanced image processing. We analyzed intersubject and intrasubject variability of pelvic tilt, measured by sagittal sacral tilt (ST) and its relationship with acetabular component tilt (AT) by using a simple method based on standard radiographs. ST was measured on lateral radiographs of pelvis including lumbosacral spine obtained in supine, sitting, standing, and lateral decubitus position for 40 asymptomatic THA patients and compared to computed tomography (CT) data obtained in supine position. AT was measured on lateral radiographs (measured acetabular tilt: MAT) in each position and compared to measurement of AT on CT and an indirectly calculated AT (CAT). Mean ST changed from supine to sitting, standing, and lateral decubitus positions as follows: 26.5 {+-} 15.5 (range 4.6-73.4 ), 8.4{+-}6.2 (range 0.6-24.5 ), and 13.4{+-}8.4 (range 0.1-24.2 ; p<0.0001, p=0.002, p=0.006). The MAT on radiographs was not significantly different from the MAT measured on CT (p=0.002) and the CAT (p=0.06). There is a good correlation between change in ST and MAT in sagittal plane (r=0.93). Measurement of ST on radiographs is a simple and reliable method to track changes in pelvic tilt in different body positions. There is significant intersubject and intrasubject variation of ST and MAT with postural changes and it may explain causes of impingement or instability following THA, which could not be previously explained. (orig.)

  14. Validation of a simple radiographic method to determine variations in pelvic and acetabular cup sagittal plane alignment after total hip arthroplasty

    Orientation of acetabular component, influenced by pelvic tilt, body position, and individual variations affects the outcome following total hip arthroplasty (THA). Currently available methods of evaluation are either imprecise or require advanced image processing. We analyzed intersubject and intrasubject variability of pelvic tilt, measured by sagittal sacral tilt (ST) and its relationship with acetabular component tilt (AT) by using a simple method based on standard radiographs. ST was measured on lateral radiographs of pelvis including lumbosacral spine obtained in supine, sitting, standing, and lateral decubitus position for 40 asymptomatic THA patients and compared to computed tomography (CT) data obtained in supine position. AT was measured on lateral radiographs (measured acetabular tilt: MAT) in each position and compared to measurement of AT on CT and an indirectly calculated AT (CAT). Mean ST changed from supine to sitting, standing, and lateral decubitus positions as follows: 26.5 ± 15.5 (range 4.6-73.4 ), 8.4±6.2 (range 0.6-24.5 ), and 13.4±8.4 (range 0.1-24.2 ; p<0.0001, p=0.002, p=0.006). The MAT on radiographs was not significantly different from the MAT measured on CT (p=0.002) and the CAT (p=0.06). There is a good correlation between change in ST and MAT in sagittal plane (r=0.93). Measurement of ST on radiographs is a simple and reliable method to track changes in pelvic tilt in different body positions. There is significant intersubject and intrasubject variation of ST and MAT with postural changes and it may explain causes of impingement or instability following THA, which could not be previously explained. (orig.)

  15. One stage total hip arthroplasty for acetabular fractures%Ⅰ期全髋关节置换治疗髋臼骨折

    王子明; 孙红振; 王爱民; 杜全印; 吴思宇; 赵玉峰; 唐颖

    2008-01-01

    目的 探讨髋臼骨折后Ⅰ期全髋关节置换(total hip arthroplasty,THA)的手术适应证和手术方法,观察其临床疗效.方法 对11例髋臼骨折患者行Ⅰ期THA.其中前柱骨折3例,后壁骨折1例,后柱骨折2例,后柱合并后壁骨折2例,横形骨折1例,横形合并后壁骨折1例,两柱骨折1例.伤后8~37 d(平均24 d)接受THA.对新鲜髋臼骨折患者,先用重建钢板或螺钉固定骨折以恢复髋臼肇的形态,将切下的股骨头制成颗粒状或块状植于髋臼内后安置臼杯.陈旧性髋臼骨折有节段性髋臼骨缺损者,将切下的股骨头制成大块状进行髋臼内结构性植骨后再安置臼杯.结果 术后3个月完全负重,无人工关节脱位.随访时间6~45个月,平均28个月.Harris评分平均78分.髋关节屈伸平均活动度为95°.X线片示1例出现髋臼松动及骨溶解征象.结论 髋臼骨折移位明显,关节软骨面损伤严重,错过了手术复位时机,可以Ⅰ期行THA.如能创造稳定的髋臼杯结构,近期临床效果满意.%Objective To explore operative indications,methods and effect of one stage total hip arthroplasty(THA)in treatment of acetabular fractures.Methods One stage total hip arthroplasty (THA)was carried out in 11 patients with acetabular fractures including 10 males and one female(at mean age of 42.4 years)8-37 days(mean24 days)after injury.There were anterior column fractures in three patients,posterior wall fracture in one,posterior column fracture in two,posterior column fracture combined with posterior wall fracture in two,transverse fracture in one,transverse fracture combined with posterior wall fracture in one and two-column fracture in one.Fresh acetabular fractures were first fixed with reconstruction plate or screws to restore shape of acestbular wall;then,granule or bulk of resected femoral head were implanted into acetabulum posterior to placement of acetabular cup prosthesis.While for old acetabular fractures,the resected

  16. Structural autograft for acetabular reconstruction in total hip arthroplasty of developmental hip dysplasia%结构植骨重建髋臼在髋关节发育不良全髋置换中的应用

    任翀旻; 张元凯; 李德强; 刘培来; 李明

    2013-01-01

    Objective To evaluate the result of bulk femoral head autograft for acetabular reconstruction in total hip arthroplasty for developmental hip dysplasia patients with severe acetabular deficiency.Methods Twenty-five patients (31 hips) with development hip dysplasia were performed with bulk femoral head autograft for the acetabular reconstruction in THA during 2005-2010.Twenty-nine hips in 23 patients were successfully followed up in average 5.1 years with mean age of 52.According to Crowe classification,19 hips in 15 patients were stage Ⅲ and 10 hips in 8 patients were stage Ⅳ.The deficient acetabula were reconstructed by bulk femoral head autograft.With bone guaranteed coverage,patients had prosthesis installed at the original level or closed level of true acetabulum.Radiographic changes and Harris score were evaluated.Results None suffered from loosening and collapse during the follow-up.One was revised for dislocation.Harris scores increased from 44 preoperative to 88 at last follow-up.Conclusion To reconstruct acetabulum at true acetabular level with satisfactory bone coverage by using bulk femoral head autograft is an effective and safe way for THA in developmental hip dysplasia.%目的 评价自体股骨头结构植骨重建髋臼在髋关节发育不良的全髋关节置换术中的效果.方法 选取2005年1月至2010年11月对髋Crowe分型在Ⅲ型和Ⅳ型的髋关节发育不良患者25例31髋,34 ~ 69岁,平均52岁;Ⅲ型15例19髋,Ⅳ型8例10髋;采用结构植骨重建髋臼的全髋关节置换术.术中行股骨头结构植骨,保证覆盖率的基础上,于真臼或近真臼水平重建髋臼并安装假体.术后行影像学检查和Harris评分.成功随访23例29髋,平均随访5.1年.结果 植骨愈合良好,无植骨塌陷,1例1髋术后脱位,所有病例无假体松动发生.术前Harris评分平均44分,术后1年平均89分,最后1次随访平均88分.结论 应用自体股骨头结构植骨,满足覆盖率前提下在真

  17. A NUMERICAL STUDY OF THE CONTACT PRESSURE BETWEEN A FEMORAL HEAD AND ACETABULAR CUP OF A TOTAL HIP REPLACEMENT

    Koukal, M.; Florian, Z.; Fuis, Vladimír

    Brno : Brno University of Technology, 2006 - (Burša, J.; Fuis, V.), s. 126-127 ISBN 80-214-3232-2. [Human Biomechanics 2006. Hrotovice (CZ), 13.11.2006-16.11.2006] R&D Projects: GA ČR(CZ) GA101/05/0136 Institutional research plan: CEZ:AV0Z20760514 Keywords : FEM * ceramic head * contact pressure * acetabular cup Subject RIV: BO - Biophysics

  18. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction.

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2016-07-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants. PMID:26469561

  19. Early outcome of hip arthroscopy for acetabular labrale tears%髋臼盂唇损伤的关节镜手术

    王卫国; 李子荣; 岳德波; 张念非; 洪闻

    2010-01-01

    Objective To investigate the clinical diagnosis and the results of arthroscopic treatment for acetabular labrale tears. Methods From November 2008 to December 2009, 21 patients with unilateral acetabular labrale tears underwent hip arthroscopy were entered in the study, including 9 males and 12 females with an average age of 37.1 years. Physical examination, X-ray examination and magnetic resonance arthrography (MRA) were carried out preoperatively to make the definite diagnosis. Of 21 cases, including labrale debridement in 14 cases, labrale debridement plus femoral osteoplasty in 5 cases and labrale repair plus osteoplasty in 2 cases. Patients were followed-up either by telephone inquiring or out-patient interview.The visual analogue scale (VAS) and Harris hip score were recorded before operation and 6 months after operation respectively. Results All 21 patients showed a positive Fadir impingement sign on the affected hips,meanwhile 15 cases showed a positive Fabir impingement sign, and positive McCarthy test was observed in 9cases. X-ray film showed 11 cases have cam type impingement, among which 6 combined with pincer type impingement. Two cases had acetabulum retroversion alone. On MRA images, signals of contrast agent infiltration in anterior superior quadrant which indicated labrale tear were observed among all cases. All labrale tears were confirmed under arthroscopy. All patients were followed up for average 11.6 months (range, 6-19).The symptoms were obviously released after operation. The VAS decreased from (5.3±1.3) preoperatively to (1.4±-0.9) 6 months postoperatively. The mean Harris hip score improved from (63±9) preoperatively to (84±10) 6 months postoperatively. All the differences had statistical significance. Conclusion Acetabular labrale injury has a close correlation with femoroacetabular impingement. Impingement test and MRA have a high sensitivity and accuracy on clinical diagnosis of labrale tears. Arthroscopic debridement, repair and

  20. THEEMPIRICAL STUDY TO THE PATHOLOGICAL CHANGES OF ACETABULAR CHONDROCYTE IN THE DEVELOPMENTAL DISLOCATION OF THE HIP%发育性髋脱位髋臼软骨细胞病理学改变的实验研究

    韦宜山; 刘万林; 丁良甲; 王炳海; 白锐; 李岱鹤; 赵振群

    2012-01-01

    Objective: To investigate the pathological changes of acetabular chondrocyte in the developmental dislocation of the hip( DDH). Methods: 20 rabbits of 4-week-old which female and male were not restricted had been made for the models. The back limb that the hip was flexured and the knee was extened then fixed with a plaster cast was made for DDH model group and the right side without fixationas the control group. Pelvis anteroposterior X-rays had been made on the models before the fixation and after8 - weeks fixation. The femoral head dislocation or not by shenton ' s line was discontinuity or by the femoral head was at the extabottom or extraupper quadrant of the Perkin squarse. Observing the changes of general shape of bilateral acetabular and the changes of chondrocyte, then observing the apoptosis of acetabular chondrocyte in 12 successful models. Results: Success rate of DDH models were60% ( 12/20). Hip X-ray of experimental side shown that the femoral head was dislocation toward the extabottom or extraupper quadrant of the Perkin squarse, the acetabular angle of the experimental was significantly increased than the control side(P<0. 05). The experimental side was found that the acetabulum became narrowing and fiied with soft tissue and the color of cartilage changed into dark,the chondrocytes were sparse and in a mess. Transmission electron microscopy results shown that the chromatin of acetabular chondrocytes were margination and condensation, the nuclear shape was irregular, the cytoplasmic vacuoles were present. Apoptosis rate of acetabular chondrocytes in experimental side was higher than the control side(P<0. 05). Conclusion; Excessive apoptosis of acetabular chondroctes may take part in the regulation of acetabular cartilage dysplasia in DDH.%目的:探讨发育性髋脱位(DDH)髋关节结构内髋臼软骨细胞的病理学变化.方法:选取出生4W的新西兰大耳白兔20只,雌雄兼用,采用兔后肢屈髋伸膝位管型石膏固定制作DDH

  1. Biomechanics of acetabular CE angle and direction of hip joint acting force%髋臼CE角及关节作用力方向的生物力学作用

    邬培慧; 傅明; 康焱; 张志奇; 杨子波; 廖威明

    2011-01-01

    目的 探讨髋臼CE角及关节作用力方向对髋关节生物力学的影响.方法 基于髋关节CT扫描图像,利用计算机辅助设计技术,建立一系列不同CE角的髋关节三维有限元模型,通过股骨头中心施加7种不同大小及方向的关节作用力,应用有限元非线性面-面接触分析方法,研究髋臼关节软骨内应力大小和分布情况以及股骨头位移.结果 当CE角减小时,髋臼软骨应力峰值平均值逐渐由1.70 MPa增大至7.89 MPa,应力分布区域面积逐渐减小,股骨头向关节外位移距离由0.04 mm增大至2.88 mm;对于CE角较小的髋关节,关节作用力方向趋向人体纵轴时,可不同程度增大髋臼软骨内应力峰值及股骨头位移距离.结论 髋关节CE角以及关节作用力方向是影响髋关节生物力学的两个重要因素.%Objective To study the effect of acetabular Center-edge (CE) angle and joint acting force direction on biomechanics of hip joint. Methods Three-dimensional hip joint models with different acetabular CE angles were established using computer-aided design (CAD) techniques according to the CT-scan images. Seven joint acting forces were loaded on the hip joint through the center of femur head from different directions. Stress on acetabular cartilage and displacement of femur head were studied by finite-element non-linear analysis. Results The average peak stress on acetabular cartilage increased to 7.89 MPa from 1.70 MPa, the distribution area of stress decreased gradually, and the distance from femur head displacement to the extra-hip joint increased to 2.88 mm from 0.04 mm when the acetabular CE angle was small. The vertical direction of joint acting force on hip joint with a smaller CE angle increased the peak stress on acetabular carti lage and the distance of femur head displacement. Conclusion CE angle and vertical acting force are the two important factors influencing the mechanics of hip joint.

  2. Measuring acetabular cup orientation on antero-posterior radiographs of the hip after total hip arthroplasty with a vector arithmetic radiological method. Is it valid and verified for daily clinical practice?

    Craiovan, B.; Weber, M.; Worlicek, M.; Schneider, M.; Springorum, H.R.; Grifka, J.; Renkawitz, T. [University Medical Center Regensburg, Bad Abbach/Regensburg (Germany). Orthopedic Surgery; Zeman, F. [University Medical Center Regensburg, Bad Abbach/Regensburg (Germany). Center for Clinical Studies

    2016-06-15

    The aim of this prospective study is to validate a vector arithmetic method for measuring acetabular cup orientation after total hip arthroplasty (THA) and to verify the clinical practice. We measured cup anteversion and inclination of 123 patients after cementless primary THA twice by two examiners on AP pelvic radiographs with a vector arithmetic method and compared with a 3D-CT based reconstruction model within the same radiographic coronal plane. The mean difference between the radiographic and the 3D-CT measurements was -1.4 ±3.9 for inclination and 0.8 ±7.9 for anteversion with excellent correlation for inclination (r=0.81, p < 0.001) and moderate correlation for anteversion (r=0.65, p < 0.001). The intraclass correlation coefficient for measurements on radiographs ranged from 0.98 (95%-CI: 0.98; 0.99) for the first observer to 0.94 (95%-CI: 0.92; 0.96) for the second observer. The interrater reliability was 0.96 (95%-CI: 0.93; 0.98) for inclination and 0.93 (95%-CI: 0.85; 0.96) for anteversion. The largest errors in measurements were associated with an extraordinary pelvic tilt. In order to get a valuable measurement for measuring cup position after THA on pelvic radiographs by this vector arithmetic method, there is a need for a correct postoperative ap view, with special regards to the pelvic tilt for the future.

  3. Denervação acetabular cranial e dorsal no tratamento da displasia coxofemoral em cães: 360 dias de evolução de 97 casos Cranial and dorsal acetabular denervation technique in treatment of hip dysplasia in dogs: 360 days evaluation of 97 cases

    Cássio R.A. Ferrigno

    2007-08-01

    Full Text Available Realizou-se a pesquisa com o intuito de avaliar os resultados clínicos da denervação acetabular cranial e dorsal por curetagem em cães com displasia coxofemoral. Foram estudados, para tanto, 97 cães, sem predileção racial ou sexual, de 1-7 anos de idade, com diagnóstico clínico e radiográfico de displasia coxofemoral. Para avaliação dos resultados da técnica cirúrgica, de curetagem das fibras nervosas do periósteo acetabular cranial e dorsal, exames clínicos foram realizados no momento pré-operatório (exame inicial, e pós-operatório, nos dias dois, sete, 14, 21, 30, 60, 180 e 360. Todos os animais foram avaliados quanto à claudicação, dor à movimentação e toque, grau de atrofia muscular, sensibilidade dolorosa ao teste de Ortolani, e qualidade de vida. A denervação reduziu a claudicação, e dor à movimentação e toque à partir de dois dias de pós-operatório, reduziu atrofia muscular aos 60 dias pós-operatórios, e melhorou a qualidade de vida dos pacientes tratados, sob a ótica dos proprietários e veterinários aos 360 dias de pós-operatório. A dener-vação acetabular dorsal é técnica factível no tratamento da dor conseqüente à displasia coxofemoral em cães, com decréscimo significativo desta após dois dias da intervenção cirúrgica, aumenta qualidade de vida e proporciona maior atividade aos pacientes com proprietários satisfeitos quanto aos resultados do procedimento. A técnica cirúrgica deve incluir a curetagem das fibras nervosas do periósteo acetabular tanto da região cranial quanto dorsal.The aim was to evaluate the clinical results of cranial and dorsal acetabular denervation using curettage in dysplastic dogs. Ninty seven dogs without distinction of breed and sex, 1 to 7 years of age, were analyzed for diagnosis and treatment of hip dysplasia, based on physical examination, clinical signs and radiographic findings. For evaluation of results of the surgical denervation technique

  4. Free iliac crest grafts with periosteum for treatment of old acetabular defects

    ZHAO De-wei; SUN Qiang; WANG Ben-jie; CUI Da-ping

    2006-01-01

    Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects.Methods: From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum, which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws.Results: Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases, good in 4 cases and fair in 2 cases.Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.

  5. Placement of the acetabular component.

    Beverland, D E; O'Neill, C K J; Rutherford, M; Molloy, D; Hill, J C

    2016-01-01

    Ideal placement of the acetabular component remains elusive both in terms of defining and achieving a target. Our aim is to help restore original anatomy by using the transverse acetabular ligament (TAL) to control the height, depth and version of the component. In the normal hip the TAL and labrum extend beyond the equator of the femoral head and therefore, if the definitive acetabular component is positioned such that it is cradled by and just deep to the plane of the TAL and labrum and is no more than 4mm larger than the original femoral head, the centre of the hip should be restored. If the face of the component is positioned parallel to the TAL and psoas groove the patient specific version should be restored. We still use the TAL for controlling version in the dysplastic hip because we believe that the TAL and labrum compensate for any underlying bony abnormality. The TAL should not be used as an aid to inclination. Worldwide, > 75% of surgeons operate with the patient in the lateral decubitus position and we have shown that errors in post-operative radiographic inclination (RI) of > 50° are generally caused by errors in patient positioning. Consequently, great care needs to be taken when positioning the patient. We also recommend 35° of apparent operative inclination (AOI) during surgery, as opposed to the traditional 45°. PMID:26733639

  6. Osteopathic diagnosis of an acetabular injury.

    Morthland, Tim; Cote, Nicholas S; Humphrey, Jon; Fulk, Doug

    2010-05-01

    Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient. PMID:20538751

  7. 发育性髋脱位髋臼软骨细胞凋亡的实验研究%The empirical study to acetabular chondrocyte apoptosis in the developmental dislocation of the hip.

    韦宜山; 刘万林; 丁良甲; 王炳海; 白锐; 李岱鹤; 赵振群

    2012-01-01

    Objective To investigate the correlation of the apoptosis of acetabular chondrocyte and expression of Bcl-2 in the developmental dislocation of the hip ( DDH). Method 20 rabbits of 4-week-old which female and male were not restricted had been made for the models. The back limb that the hip was flex-ured and the knee was extened then fixed with a plaster cast was made for DDH model group and the right side without fixation as the control group. Pelvis anteroposterior X-rays had been made on the models before the fixation and after 8-weeks fixation. The femoral head dislocation or not by shenton' s line was discontinuity or by the femoral head was at the extabottom or extraupper quadrant of the Perkin squarse. 12 successful models were sacrificed at once. Observing the changes of general shape of bilateral acetabular and the changes of chondrocyte , then observing the apoptosis and expression of Bel - 2 of acetabular chondrocyte. Results Success rate of DDH models were 60% (12/20). Hip X-ray of experimental side shown that the superior margin of acetabu-lum was blunting, the femoral head was dislocation toward the extabottom or extraupper quadrant of the Perkin squarse, the acetabular angle of the experimental was significantly increased than the control side ( P < 0. 05 ) . The experimental side was found that the acetabulum became narrowing and fiied with soft tissue and the color of cartilage changed into dark, the chondrocytes were sparse and in a mess . Transmission electron microscopy results shown that the chromatin of acetabular chondrocytes were margination and condensation , the nuclear shape was irregular, the cytoplasmic vacuoles were present. Apoptosis rate of acetabular chondrocytes in experimental side was higher than the control side ( P < 0. 05 ) . The expression of Bcl-2 of acetabular chondrocytes in experimental side was lower than the control side ( P < 0. 05 ) , apoptosis and Bcl-2 expression of acetabular chondroctes were positive correlation in

  8. Treatment of acetabular dysplasia by triple pelvic osteotomy and its short-term results

    Dogan, Ahmet; Zorer, Gazi; Ozer, Utku Erdem

    2004-01-01

    Objectives: We evaluated the effect of triple pelvic osteotomy on acetabular coverage and its clinical implications by clinical and radiographic parameters in patients with acetabular dysplasia. Methods: Triple pelvic osteotomy was performed in 21 hips of 19 patients (13 females, 6 males; mean age during operation 16.3 years; range 8 to 32 years). Acetabular dysplasia was bilateral in two, and unilateral in 17 patients. Etiology was developmental dysplasia of the hip in 12 patients, Legg-C...

  9. Efficacy observation of acetabular cups of hip replacement surgery on adult hip crowe II and III dysplasia%大臼杯全髋关节置换术治疗 CroweⅡ~Ⅲ型成人髋关节发育不良疗效观察

    谢贵杰; 何森荣; 甘伟伟

    2014-01-01

    目的:总结大型臼杯生物型人工全髋关节置换术治疗CroweⅡ~Ⅲ型成人髋关节发育的早期疗效。方法12例12髋, CroweⅡ型为7例,CroweⅢ型为5例,全髋关节置换术臼杯外径58~64 mm,假体选用国产爱康宜诚公司生产的假体。结果随访2~3年。髋关节功能Harris标准评分平均92分,其中功能优9例,良3例,目前尚无1例需行翻修。结论对部分CroweⅡ、Ⅲ型成人髋关节发育不良,采用大型臼杯全髋关节置换术治疗早期能够获得满意的临床疗效。%Objective To summize the early efficacy of large-scare acetabular cups of hip replacement surgery on adult hip Crowe II and III dysplasia .Methods There were 12 patients in which 7 cases were Crowe II and 5 cases were Crowe III .The outside diameter of acetabular cup for total hip replacement surgery was 58~64 mm.Ai-Kang prostheses which were made in China were used .Results The patients were followed up for 2 to 3 years.The average Harris hip standard score was 92.The hip functions of 9 cases were excel-lent and those of 3 cases were good .No case needed to restore .Conclusions For some cases of adult hip Crowe II and III dysplasia , early hip replacement surgery with large-scare acetabular cups can obtain satisfactory clinical effect .

  10. Hip instability.

    Smith, Matthew V; Sekiya, Jon K

    2010-06-01

    Hip instability is becoming a more commonly recognized source of pain and disability in patients. Traumatic causes of hip instability are often clear. Appropriate treatment includes immediate reduction, early surgery for acetabular rim fractures greater than 25% or incarcerated fragments in the joint, and close follow-up to monitor for avascular necrosis. Late surgical intervention may be necessary for residual symptomatic hip instability. Atraumatic causes of hip instability include repetitive external rotation with axial loading, generalized ligamentous laxity, and collagen disorders like Ehlers-Danlos. Symptoms caused by atraumatic hip instability often have an insidious onset. Patients may have a wide array of hip symptoms while demonstrating only subtle findings suggestive of capsular laxity. Traction views of the affected hip can be helpful in diagnosing hip instability. Open and arthroscopic techniques can be used to treat capsular laxity. We describe an arthroscopic anterior hip capsular plication using a suture technique. PMID:20473129

  11. Influence of clinical and radiological variables on the extent and distribution of periprosthetic osteolysis in total hip arthroplasty with a hydroxyapatite-coated multiple-hole acetabular component: a magnetic resonance imaging study.

    Pérez-Coto, Iván; Hernández-Vaquero, Daniel; Suárez-Vázquez, Abelardo; Sandoval-García, Manuel Ángel; Escandon-Rodriguez, Ana

    2014-10-01

    Polyethylene wear-induced osteolysis constitutes the most severe long-term complication of total hip arthroplasties (THA). Our aim was to assess through MRI the severity and growth pattern of osteolysis, as well as the influence clinical-radiographic variables exert. We analyzed 75 THA with an average evolution time of 13.67years. The implant was a titanium alloy, non-cemented, multiple-hole model with hydroxyapatite coating. Osteolysis was found with a peripheral pattern in 48 and a central pattern in 6; in 52 cases it was continuous, and in 4, isolated. Out of 118 screws, 20 exhibited lysis. There was a proportional correlation between osteolysis severity and wear rate with age, physical activity and acetabular abduction, as well as an association between said variables and peripheral and continuous patterns. PMID:24986509

  12. The use of allograft bone in reconstruction of the acetabulum during hip revision arthroplasty

    We have reviewed 80 patients who underwent an allograft acetabular reconstruction between 1987 and 1995. This group had a mean age of 66 years with a mean follow-up of 5.2 years. A mean preoperative Harris hip score of 32 points was improved to a mean postoperative score of 72 points. There was a 16.5% rerevision rate. Acetabular defects were classified according to the American Academy of Orthopaedic Surgeons system. Subgroup classification categories were analysed and reconstruction methodologies have been devised. This paper deals with the relative indications for the use of morsellised bone, block allografts, anatomic specific allografts and reconstruction shells according to type of acetabular defects

  13. Options for acetabular fixation surfaces.

    Klika, Alison K; Murray, Trevor G; Darwiche, Hussein; Barsoum, Wael K

    2007-01-01

    Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have

  14. Instrumented hip implants: electric supply systems.

    Soares dos Santos, Marco P; Ferreira, Jorge A F; Ramos, A; Simões, José A O; Morais, Raul; Silva, Nuno M; Santos, Paulo M; Reis, M J C S; Oliveira, T

    2013-10-18

    Instrumented hip implants were proposed as a method to monitor and predict the biomechanical and thermal environment surrounding such implants. Nowadays, they are being developed as active implants with the ability to prevent failures by loosening. The generation of electric energy to power active mechanisms of instrumented hip implants remains a question. Instrumented implants cannot be implemented without effective electric power systems. This paper surveys the power supply systems of seventeen implant architectures already implanted in-vivo, namely from instrumented hip joint replacements and instrumented fracture stabilizers. Only inductive power links and batteries were used in-vivo to power the implants. The energy harvesting systems, which were already designed to power instrumented hip implants, were also analyzed focusing their potential to overcome the disadvantages of both inductive-based and battery-based power supply systems. From comparative and critical analyses of the methods to power instrumented implants, one can conclude that: inductive powering and batteries constrain the full operation of instrumented implants; motion-driven electromagnetic energy harvesting is a promising method to power instrumented passive and active hip implants. PMID:24050511

  15. Arthroscopic hip labral repair.

    Philippon, Marc J; Faucet, Scott C; Briggs, Karen K

    2013-05-01

    Labral tears in the hip may cause painful clicking or locking of the hip, reduced range of motion, and disruption to sports and daily activities. The acetabular labrum aids stabilization of the hip joint, particularly during hip motion. The fibrocartilaginous structure extends the acetabular rim and provides a suction seal around the femoroacetabular interface. Treatment options for labral tears include debridement, repair, and reconstruction. Repair of the labrum has been shown to have better results than debridement. Labral refixation is achieved with sutures anchored into the acetabular rim. The acetabular rim is trimmed either to correct pincer impingement or to provide a bleeding bed to improve healing. Labral repair has shown excellent short-term to midterm outcomes and allows patients to return to activities and sports. Arthroscopic rim trimming and labral refixation comprise an effective treatment for labral tears with an underlying diagnosis of femoroacetabular impingement and are supported by the peer-reviewed literature. PMID:23875153

  16. Three-dimensional computed tomography analysis of non-osteoarthritic adult acetabular dysplasia

    Ito, Hiroshi; Matsuno, Takeo; Hirayama, Teruhisa; Tanino, Hiromasa; Yamanaka, Yasuhiro [Asahikawa Medical College, Department of Orthopaedic Surgery, Asahikawa (Japan); Minami, Akio [Hokkaido University School of Medicine, Department of Orthopaedic Surgery, Sapporo (Japan)

    2009-02-15

    Little data exists on the original morphology of acetabular dysplasia obtained from patients without radiographic advanced osteoarthritic changes. The aim of this study was to investigate the distribution and degree of acetabular dysplasia in a large number of patients showing no advanced degenerative changes using three-dimensional computed tomography (3DCT). Eighty-four dysplastic hips in 55 consecutive patients were studied. All 84 hips were in pre- or early osteoarthritis without radiographic evidence of joint space narrowing, formation of osteophytes or cysts, or deformity of femoral heads. The mean age at the time of CT scan was 35 years (range 15-64 years). 3D images were reconstructed and analyzed using recent computer imaging software (INTAGE Realia and Volume Player). Deficiency types and degrees of acetabular dysplasia were precisely evaluated using these computer software. The average Harris hip score at CT scans was 82 points. Twenty-two hips (26%) were classified as anterior deficiency, 17 hips (20%) as posterior deficiency, and 45 hips (54%) as lateral deficiency. No significant difference was found in the Harris hip score among these groups. The analysis of various measurements indicated wide variations. There was a significant correlation between the Harris hip score and the acetabular coverage (p < 0.001). Our results indicated wide variety of deficiency type and degree of acetabular dysplasia. Hips with greater acetabular coverage tended to have a higher Harris hip score. (orig.)

  17. 全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效分析%Analysis Curative Effect of Total Hip Arthroplasty in Treatment of Adult Acetabular Dysplasia With Bad Osteoarthritis Secondary

    时梦猇

    2015-01-01

    Objective To observe curative effect of total hip arthroplasty in treatment of adult acetabular dysplasia with bad osteoarthritis secondary. Methods Retrospective analyzed the clinical data of total hip arthroplasty of adult acetabular dysplasia with bad osteoarthritis secondary. Results The symptoms of pain disappeared, and the body was short and the case was correct. The acetabular angle was located at 35 to 40 angle, and the CE angle of the prosthesis was more than 20 angle. No prosthesis loosening, fracture of acetabulum, handle, neurovascular injury and so on. The excellent and good rate of postoperative Harris hip score was 94.6%. Conclusion The effect of total hip arthroplasty on adult acetabular dysplasia with bad osteoarthritis secondary os obvious.%目的 观察全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效.方法 回顾性分析在我院接受全髋关节置换术治疗的成人髋臼发育不良继发骨性关节炎患者临床资料.结果 疼痛症状基本消失,肢体短缩情况矫正良好.髋臼角位于35°~40°,假体CE角>20°,无假体臼、柄松动、骨折、神经血管损伤等发生.患者术后Harris髋关节功能评分优良率94.6%.结论 全髋关节置换术治疗成人髋臼发育不良继发骨性关节炎疗效明显.

  18. Acetabular paralabral cyst: an uncommon cause of sciatica

    Sherman, P.M.; Sanders, T.G. [Department of Radiology, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States); Matchette, M.W. [University of Texas Medical School, 7703 Floyd Curl Drive, San Antonio, TX 78229-3900 (United States); Parsons, T.W. [Department of Orthopedic Surgery, Wilford Hall Medical Center, 2200 Bergquist Drive, Ste. 1, Lackland AFB, TX 78236 (United States)

    2003-02-01

    The association between tears of the acetabular labrum and paralabral cysts has been well documented, and magnetic resonance imaging (MRI) has been shown to be the most accurate noninvasive method of depicting not only the normal anatomic structures of the hip, but also the common pathologic processes such as labral tears and paralabral cysts. We present the case of an acetabular paralabral cyst that resulted in clinically symptomatic compression of the sciatic nerve. (orig.)

  19. CONSERVATIVE TREATMENT OF HIP DYSPLASIA

    Mikhail Mikhailovich Kamosko; Mahmoud Stanislavovich Poznovich

    2014-01-01

    Hip dysplasia in children is the subject of careful study by specialists both in our country and abroad. There are three basic variants of hip dysplasia: congenital acetabular dysplasia, congenital subluxation of the hip and congenital dislocation of the hip. However, treatment of congenital dislocation of the hip, which is the most severe form of hip dysplasia in children, currently remains one of the topical problems of children’s orthopedics, despite the significant achievements of modern ...

  20. PATHOLOGICAL AND MORPHOLOGICAL RESEARCH OF EXPERIMENTAL ACETABULAR DYSPLASIA

    张自明; 马瑞雪; 吉士俊; 牛之彬

    2004-01-01

    Objective To investigate the pathological mechanism of hip dysplasia. Methods The left knee joints of eighteen rabbits were fixed in extending position with plaster cylinder for four weeks, but their hip joints were flexed. The right side served as control. Roentgenogram was made in all animals. The changes of the xray films and the pathological findings between left and right hips were compared. Results Appearance of hip dysplasia was obvious at four weeks after plaster fixation. There were pathological changes, including shallow acetabulum and flat femoral head, increased acetabular index and decreased acetabular head index on the x-ray films.Conclusion The hip dysplasia is the result of prolonged extending position of the knee joint. Abnormal knee posture seems to be one of the important factors of hip dysplasia. This kind of deformation may be worsened with time.

  1. Analysis of the Effect of Artificial Hip Replacement in the Treatment of Acetabular Defect%髋臼缺损畸形的人工髋关节置换手术疗效分析

    武豪杰

    2015-01-01

    Objective To study the acetabulum defect deformity treatment methods of artificial total hip replacement. Methods 30 cases of acetabular defects were selected in our hospital, including 13 cases of acetabulum hypoplasia, acetabulum fracture malunion after trauma in 5 cases, 6 patients with rheumatoid arthritis, ankylosing spondylitis hip lesions, 6 cases were performed total hip replacement, take the acetabulum deepening, double cone spiral acetabulum, autologous bone graft and structural methods such as titanium mesh and bone graft line true acetabular reconstruction, all patients preoperative CT three-dimensional reconstruction, with Harris scoring criteria. Results Followed up for 6~36 months, has not occurred during the follow-up period of artificial hip prosthesis loosening and fracture around, etc. Harris scoring (36±6.5) preoperatively, postoperative (93±5.2). Conclusion Deformity of total hip replacement for defects of acetabulum, through the acetabulum, Zweymulle double cone spiral acetabulum, grain pressure distribution, structural bone graft autologous bone graft and titanium mesh and bone graft and so on the many kinds of methods can be a very good reconstruction of acetabulum, restore good stability and the Harris score, can achieve very good effect.%目的探讨髋臼缺损畸形的人工全髋关节置换术的处理方法。方法选取我院收治存在髋臼缺损畸形患者30例,包括髋臼发育不良13例、髋臼创伤骨折后畸形愈合5例、类风湿性关节炎6例,强直性脊柱炎髋关节病变6例,均行全髋关节置换术,采取髋臼加深、双锥  面螺旋型髋臼、自体结构性植骨及钛网加植骨等多种方法行真臼重建,全部病例术前行 CT 三维重建,评分标准采用 Harris 评分。结果随访6~36个月,随访期间未发生人工髋关节假体松动、周围骨折等。Harris 评分术前(36±6.5),术后(93±5.2)。结论对于髋臼缺损畸形的全髋关节置

  2. 自体骨植骨在成人先天性髋臼发育不良全髋关节置换术中的疗效分析%Autogenous bone grafting in total hip arthroplasty for congenital acetabular dysplasia

    周垂宝; 李明; 张元凯

    2012-01-01

    To discuss the effect of the femoral-head autograft in uncemented total hip arthroplasty for congenital acetabular dysplasia. Methods 21 patients(24 hips) with acetabular dysplasia (Crowe type Ⅱ orⅢ ) from August 2007 to May 2010 received femoral head autograft in cementless total hip arthroplasty for acetabular dysplasia to reconstruct acetabula. Classified Harris Hip Score (CHHS) and imaging examination were used in the follow-up visit. Results There was a significant difference between the pre and post operation according to CHHS (P <0.05). At an average follow-up of 27 months,all the patients had excellent clinical results. Neither acetabular autograft resorption nor non-union was observed. Conclusion Using femoral-head autograft was an effect method in uncemented total hip arthroplasty for the acetabular dysplasia.%目的 分析成人先天性髋臼发育不良全髋关节置换术中使用自体骨结构性移植重建髋臼的疗效.方法 2007年8月至2010年5月手术治疗先天性髋臼发育不良CroweⅡ、Ⅲ型患者21例(24髋),男3例(3髋),女18例(21髋),行非骨水泥型全髋关节置换术,应用自体股骨头植骨重建髋臼,随访指标为Harris评分和影像学检查.结果 Harris评分统计分析显示,术前与术后差异有统计学意义(P<0.05),移植骨愈合,无移植骨的吸收.结论 自体骨结构性植骨在非骨水泥型全髋关节置换治疗先天性髋臼发育不良中有良好疗效.

  3. Relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index, and medial acetabular bone stock

    Werner, Clement M.L. [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland); University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Copeland, Carol E.; Stromberg, Jeff; Turen, Clifford H. [University of Maryland Medical Systems, R. Adams Cowley Shock Trauma Center, Baltimore, MD (United States); Ruckstuhl, Thomas; Bouaicha, Samy [Balgrist University Hospital Zurich, Department of Orthopaedics, Zurich (Switzerland)

    2011-11-15

    Knowledge of acetabular anatomy is crucial for cup positioning in total hip replacement. Medial wall thickness of the acetabulum is known to correlate with the degree of developmental dysplasia of the hip (DDH). No data exist about the relationship of routinely used radiographic parameters such as Wiberg's lateral center edge angle (LCE-angle) or Lequesne's acetabular index (AI) with thickness of the medial acetabular wall in the general population. The aim of our study was to clarify the relationship between LCE, AI, and thickness of the medial acetabular wall. Measurements on plain radiographs (LCE and AI) and axial CT scans (quadrilateral plate acetabular distance QPAD) of 1,201 individuals (2,402 hips) were obtained using a PACS imaging program and statistical analyses were performed. The mean thickness of the medial acetabulum bone stock (QPAD) was 1.08 mm (95% CI: 1.05-1.10) with a range of 0.1 to 8.8 mm. For pathological values of either the LCE (<20 ) or the AI (>12 ) the medial acetabular wall showed to be thicker than in radiological normal hips. The overall correlation between coxometric indices and medial acetabular was weak for LCE (r =-0.21. 95% CI [-0.25, -0.17]) and moderate for AI (r = 0.37, [0.33, 0.41]). We did not find a linear relationship between Wiberg's lateral center edge angle, Lequesne's acetabular index and medial acetabular bone stock in radiological normal hips but medial acetabular wall thickness increases with dysplastic indices. (orig.)

  4. The early-term clinical efficacy of titanium trabecular metal acetabular components produced by E-beam technology in total hip arthroplasty%3D打印钛合金骨小梁金属臼杯全髋关节置换术的短期疗效

    程文俊; 勘武生; 郑琼; 王俊文; 徐海军; 肖志宏

    2014-01-01

    Objective To explore the early-term efficacy of porous titanium trabecular metal acetabular (TTM) compo-nents produced by E-beam technology in total hip arthroplasty(THA). Methods From May 2012 to JUN 2013, nineteen primary THA patients (20 hips) were devided into observation group of porous TTM acetabular prosthesis produced by E-beam technology and control group of Pinnacle acetabular prosthesis. TTM group had nine patients (10 hips), including 7 males and 2 females, with the mean age of 61.0 years. Pinnacle group had ten patients (10 hips), including 6 males and 4 females, with the mean age of 58.6 years. The patients were followed up at the 6,12,24 weeks after operation. X-rays were taken at the follow-ups. Acetabular compo-nent stability and osseointegration were assessed through radiograph. Harris scores system,SF-36 Heath Survey Questionnaire and WOMAC Osteoarthritis index were recorded before and after operation to evaluate clinical effects of surgery. Results In TTM group, the Harris score improved from 48.2 ± 5.5 preoperatively to 89.5 ± 4.0 postoperatively, SF-36 scores from 329.1 ± 86.7 to 763.8 ± 15.1, and WOMAC index from 18.8 ± 11.0 to 1.3 ± 0.9. No cases suffered aseptic loosening and migration. After 24 weeks, There was no significant difference regarding Harris scores system,SF-36 Heath Survey Questionnaire and WOMAC Os-teoarthritis index between two groups. In TTM group, two hips had a radiolucent line postoperatively, which occurred in 2 and 3 zone. The lines were disappeared 24 weeks later. Conclusion In THA, the initial stability of TTM produced by E-beam tech-nology was fine, which can facilitate bone ingrowth in early stage. However, the long-term follow-up effect still needs to be con-firmed.%目的:评估3D打印钛合金骨小梁金属(titanium trabecular metal,TTM)臼杯在初次全髋关节置换术(total hip arthroplasty, THA)中应用的短期疗效。方法2012年5月至2013年6月,选取19例(20髋)进行初

  5. Sciatic Nerve Injury Associated with Acetabular Fractures

    Issack, Paul S; Helfet, David L

    2008-01-01

    Sciatic nerve injuries associated with acetabular fractures may be a result of the initial trauma or injury at the time of surgical reconstruction. Patients may present with a broad range of symptoms ranging from radiculopathy to foot drop. There are several posttraumatic, perioperative, and postoperative causes for sciatic nerve palsy including fracture–dislocation of the hip joint, excessive tension or inappropriate placement of retractors, instrument- or implant-related complications, hete...

  6. Influence of hip dysplasia on the development of osteoarthritis of the hip

    A.M. Lievense (Annet); S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne); J.A.N. Verhaar (Jan); B.W. Koes (Bart)

    2004-01-01

    textabstractBACKGROUND: It has been suggested that in some patients with primary hip osteoarthritis (OA), the disease occurs as a consequence of acetabular dysplasia or hip dysplasia (HD). OBJECTIVE: To carry out a systematic review to investigate the association between acetabular

  7. Loosening After Acetabular Revision

    Beckmann, Nicholas A.; Weiss, Stefan; Klotz, Matthias C.M.;

    2014-01-01

    The best method of revision acetabular arthroplasty remains unclear. Consequently, we reviewed the literature on the treatment of revision acetabular arthroplasty using revision rings (1541 cases; mean follow-up (FU) 5.7 years) and Trabecular Metal, or TM, implants (1959 cases; mean FU 3.7 years)...

  8. Influence of hip dysplasia on the development of osteoarthritis of the hip

    Lievense, Annet; Bierma-zeinstra, Sita; Verhagen, Arianne; Verhaar, JAN; Koes, Bart

    2004-01-01

    textabstractBACKGROUND: It has been suggested that in some patients with primary hip osteoarthritis (OA), the disease occurs as a consequence of acetabular dysplasia or hip dysplasia (HD). OBJECTIVE: To carry out a systematic review to investigate the association between acetabular dysplasia and hip OA. METHODS: A database search of Medline, Embase, and the Cochrane library was carried out, and articles that aimed at studying the relationship between HD and hip OA were identified. The methodo...

  9. Cross-cultural adaptation to Swedish and validation of the Copenhagen Hip and Groin Outcome Score (HAGOS) for pain, symptoms and physical function in patients with hip and groin disability due to femoro-acetabular impingement

    Thomeé, Roland; Jónasson, Pall; Thorborg, Kristian;

    2014-01-01

    PURPOSE: There is a lack of standardised outcome measures in Swedish for active, young and middle-aged patients with hip and groin disability. The purpose of this study was to adapt the Danish version of the Copenhagen Hip and Groin Outcome Score (HAGOS) patient-reported outcome instrument for us...

  10. MR imaging findings of acetabular dysplasia in adults

    James, Steven; Connell, David [The Royal National Orthopaedic Hospital, Radiology Department, London, Middlesex (United Kingdom); Miocevic, Miranda; Malara, Frank; Pike, Jonathan [Victoria House Hospital, Radiology Department, Melbourne (Australia); Young, David [Melbourne Orthopaedic Group, Orthopaedic Surgery, Melbourne (Australia)

    2006-06-15

    To evaluate the diagnostic accuracy of MR imaging in the identification of labral and articular cartilage lesions in patients with acetabular dysplasia. Pre-operative MR imaging was performed on 27 hips in 25 consecutive patients (16 males, 9 females, age range 19-52 years, mean age 31.2 years) with radiographic evidence of acetabular dysplasia (centre-edge angle of Wiberg <20 degrees). The average duration of symptoms was 16.2 months. Two musculoskeletal radiologists assessed MR images in consensus for the presence of abnormality involving the acetabular labrum and adjacent acetabular articular cartilage. A high resolution, non-arthrographic technique was used to assess the labrum and labral chondral transitional zone. Surgical correlation was obtained in all cases by a single surgeon experienced in hip arthroscopy and ten patients with normal hip MRI were included to provide a control group. The acetabular labra in the dysplastic hips demonstrated abnormal signal intensity, and had an elongated appearance when compared with the control group (mean length 10.9 mm vs 6.4 mm). Morphological appearances in the labra included surface irregularity, fissures and cleft formation. MR imaging correctly identified the severity of chondral abnormality in 24 of 27 hips (89%) when compared with arthroscopic findings. MR imaging demonstrates an elongated labrum, focal intra-substance signal change and irregularity and fissuring of the margins in patients with acetabular dysplasia. Abnormality is also identified at the labral chondral transitional zone, where fissuring, focal clefts, chondral deficiency and subchondral cyst formation may be apparent. A high-resolution, non-arthrographic technique can provide an accurate preoperative assessment and evaluate the presence of premature osteoarthritis. (orig.)

  11. Assessment of outcome after hip fracture: development of a universal assessment system for hip fractures

    Bowers Thomas M.; Parker Martyn J.

    2016-01-01

    Background: The aim of the study was to refine current evaluation systems used to assess outcome after a hip fracture and to devise a simple and practical system to assess all hip fracture patients. Methods: Three continuous scales were defined for pain, mobility and functional independence. These were all found to have an acceptable degree of inter-observer agreement. The pre-fracture mobility and independence scores were related to the one-year mortality for a consecutive se...

  12. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

    Nitschke, Ashley [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology, Aurora, CO (United States); Lambert, Jeffery R. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); Glueck, Deborah H. [University of Colorado, Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO (United States); University of Colorado School of Medicine, University of Colorado Denver, Department of Radiology, Aurora, CO (United States); Jesse, Mary Kristen; Strickland, Colin [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Mei-Dan, Omer [University of Colorado School of Medicine, University of Colorado Denver, Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, Aurora, CO (United States); Petersen, Brian [University of Colorado School of Medicine, University of Colorado Denver, Division of Musculoskeletal Radiology, Department of Radiology and Orthopaedics, Aurora, CO (United States); Inland Imaging, Division of Musculoskeletal Radiology, Spokane, WA (United States)

    2015-11-15

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain. (orig.)

  13. Validation of a new radiographic measurement of acetabular version: the transverse axis distance (TAD)

    This study has three aims: (1) validate a new radiographic measure of acetabular version, the transverse axis distance (TAD) by showing equivalent TAD accuracy in predicting CT equatorial acetabular version when compared to a previously validated, but more cumbersome, radiographic measure, the p/a ratio; (2) establish predictive equations of CT acetabular version from TAD; (3) calculate a sensitive and specific cut point for predicting excessive CT acetabular anteversion using TAD. A 14-month retrospective review was performed of patients who had undergone a dedicated MSK CT pelvis study and who also had a technically adequate AP pelvis radiograph. Two trained observers measured the radiographic p/a ratio, TAD, and CT acetabular equatorial version for 110 hips on a PACS workstation. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of p/a ratio and TAD. CT equatorial acetabular version can accurately be predicted from either p/a ratio (p < 0.001) or TAD (p < 0.001). The diagnostic accuracies of p/a ratio and TAD are comparable (p =0.46). Patients whose TAD is higher than 17 mm may have excessive acetabular anteversion. For that cutpoint, the sensitivity of TAD is 0.73, with specificity of 0.82. TAD is an accurate radiographic predictor of CT acetabular anteversion and provides an easy-to-use and intuitive point-of-care assessment of acetabular version in patients with hip pain. (orig.)

  14. Surgical treatment for complex acetabular fractures

    LIU Qiang; WU Dou; LI Ping; HAN Shu-feng

    2006-01-01

    Objective: To explore the effect of surgical treatment on complex acetabular fractures.Methods: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean = 38. 5 years ) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.Results: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score > 80 points). The rate of excellent and good was about 86 %.Conclusions: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.

  15. Transosseous Acetabular Labral Repair as an Alternative to Anchors

    Pérez-Carro, Luis; Cabello, Andres Gonzalez; Rakha, Mohamed Ibrahim; Patnaik, Sarthak; Centeno, Elias; Miranda, Victor; Fernández, Ana Alfonso

    2015-01-01

    Labral tears are the most common pathology in patients undergoing hip arthroscopy and the most common cause of mechanical hip symptoms. Labral repair techniques have been described in the literature using suture anchors placed as close as possible to the acetabular rim without penetrating the articular surface. Optimal surgical technique for labral repair is very important, and an inappropriate entry point and guide angulation may lead to intra-articular penetration of the anchor, chondral da...

  16. Computer aided technology assesses adult acetabular dysplasia after total hip arthroplasty:biological performance%计算机辅助技术评价成人髋臼发育不良全髋关节置换生物性能分析

    邵正海; 徐卫东

    2016-01-01

    背景:目前,全髋关节置换是公认的治疗成人先天性髋臼发育不良首选治疗方法。但是,患者治疗过程中尚缺乏理想的评价方法精确的解决髋臼重建问题。目的:探讨计算机辅助技术在成人髋臼发育不良全髋关节置换中的评价效果及生物性能研究。方法:选取长海医院骨关节外科2015年1至8月收治的80例成人先天性髋臼发育不良患者资料进行分析,入选患者均行全髋关节置换治疗,采用随机对照方法将患者分为对照组和计算机辅助技术组,两组置换前均采用 CT 扫描,计算机辅助技术组采用 M3D 可视化软件对髋臼部位进行三维重建、测量以及手术预演等,比较两组患者全髋关节置换效果及生物性能。结果与结论:两组患者置换后均一期愈合。与对照组相比,计算机辅助技术组优良率、治疗后 Harris 评分、置换后髋臼假体外翻角、前倾角显著高于对照组(P <0.05),而髋臼杯外展角偏移度以、髋臼杯前倾角偏移度、置换后并发症发生率显著减小(P <0.05)。结果提示,成人髋臼发育不良全髋关节置换中采用计算机辅助评价效果理想,能够准确的把握真臼解剖特点及与假体的对应关系,帮助患者选择合适的髋臼和假体及髋臼重建方式,提高置换后髋臼的生物性能,具有较高的临床应用价值。%BACKGROUND: Currently, total hip arthroplasty is a recognized and preferred method for treatment of adult congenital acetabular dysplasia, however, there were lack of ideal evaluation methods to precisely solve acetabular reconstruction in the process of treatment. OBJECTIVE: To investigate the evaluating effects and biological properties of computer aided technology in adult acetabular dysplasia after total hip arthroplasty.METHODS: The clinical data from 80 patients with adult congenital acetabular dysplasia who received the treatment at Department of

  17. Relationship between sacral pelvic incidence and acetabular orientation.

    Legaye, Jean; Duval-Beaupere, Ginette; Barrau, Andre; Boulay, Christophe; Hecquet, Jerome; Montigny, Jean-Pierre; Tardieu, Christine

    2011-01-01

    The importance of the sacral pelvic incidence (SPI) in relation to individual variations of sagittal spinal curvature has become well-recognised. We attempted to determine the relationship between SPI and acetabular orientation. The three-dimensional coordinates of 47 homologous points were observed on 51 adult anatomical pelvises (26 female and 25 male). The reference vertical plane was Lewinnek's anterior pelvic plane. 10 angular parameters and 11 linear parameters were defined and calculated. These were expressed both in absolute value (in millimetres) and in "acetabular unit" (relative to the mean value of the right and left acetabular rays). Mean values of the parameters were calculated for all pelvises and according to gender. There were two dominant parameters: the "sacral slope" and the "V pubic angle". "Acetabular tilting" was primarily dependent on the "sacral slope" and its intermediary on the "SPI", while "acetabular anteversion" dependent on the "V pubic angle" via the "angle of prow". It is recommended that positioning of the acetabular cup in total hip arthroplasty relates to anatomical parameters, and to the global sagittal balance of the pelvi-spinal unit. PMID:21279971

  18. CONSERVATIVE TREATMENT OF HIP DYSPLASIA

    Михаил Михайлович Камоско

    2014-12-01

    Full Text Available Hip dysplasia in children is the subject of careful study by specialists both in our country and abroad. There are three basic variants of hip dysplasia: congenital acetabular dysplasia, congenital subluxation of the hip and congenital dislocation of the hip. However, treatment of congenital dislocation of the hip, which is the most severe form of hip dysplasia in children, currently remains one of the topical problems of children’s orthopedics, despite the significant achievements of modern medicine. In spite of the large amount of research in this field, treatment principles of hip dysplasia are still under discussion.

  19. Techniques and results for open hip preservation

    David eLevy

    2015-12-01

    Full Text Available While hip arthroscopy grows in popularity, there are still many circumstances under which open hip preservation is most appropriately indicated. This article specifically reviews open hip preservation procedures for a variety of hip conditions. Femoral acetabular impingement may be corrected using an open surgical hip dislocation. Acetabular dysplasia may be corrected using a periacetabular osteotomy. Acetabular protrusio may require surgical hip dislocation with rim trimming and a possible valgus intertrochanteric osteotomy. Legg-Calve ́-Perthes disease produces complex deformities that may be better served with osteotomies of the proximal femur and/ or acetabulum. Chronic slipped capital femoral epiphysis (SCFE may also benefit from a surgical hip dislocation and/or proximal femoral osteotomy.

  20. Imaging diagnosis of acetabular dysplastic coxarthrosis in adult

    Objective: To investigate the imaging diagnosis of acetabular dysplastic coxarthrosis. Method: The imaging of the acetabular dysplasia was analyzed in 51 patients (87 hips). All but four patients were women. The age ranged from 22 to 78 years, and the mean age was 42.6 years. Pelvis radiographs were studied in all cases, and CT scan was performed in 18 cases and MRI in 10 cases. Results: The fundamental signs on the plain film included shallow acetabulum, increased obliquity and insufficient coverage of the femoral head by the acetabulum. The CE angles were determined in all the cases, ranging from -10 degree to 30 degree, mean 12.9 degree. The sharp angles ranged from 35 degree to 67 degree, mean 45.3 degree. The secondary osteoarthritis were revealed in 75 hips (84.2%). 54 hips (62.1%) had cyst-like lesions in weight-bear area of the acetabulum or femoral head. 19 hips had subluxation of femoral head. CT and MRI displayed small cyst-like lesions and forward shift of the femoral head, which could not be shown on plain film, respectively in 13 and 10 hips. Conclusion: The cyst-like lesion of subarticular region is a common sign in acetabular dysplastic coxarthrosis. CT or MRI can show the early osteolytic lesion and forward subluxations

  1. One stage treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures with total hip arthroplasty%Ⅰ期全髋置换术治疗合并股骨头或股骨颈骨折的髋臼骨折

    唐孝明; 张耀明; 袁加斌; 庞健; 王跃

    2008-01-01

    目的 探讨全髋关节置换术(total hip arthroplasty,THA)治疗合并股骨头或股骨颈骨折的髋臼骨折方法、手术特点和疗效.方法 对7例合并股骨头或股骨颈骨折的髋臼骨折行Ⅰ期THA.髋臼骨折按AO分型:A型1例,B型3例,C型3例.股骨头骨折1例,股骨颈骨折6例.伤后7~21 d接受THA,5例行髋臼复位内固定后采用生物型髋臼,2例金属加强环配合骨水泥固定髋臼,股骨侧均采用生物型固定.结果 6例得到随访,平均随访时间3年9个月(2年3个月~6年5个月),出现脱位1例,经手法复位后未再脱位,1例出现异位骨化.所有随访患者髋关节功能均有明显改善,Harris评分术前平均48分,术后提高到91分.随访期内未发现假体松动.结论 THA是治疗合并同侧股骨头或股骨颈骨折髋臼骨折的有效方法,能显著改善关节功能,避免多次手术.%Objective To discuss method,operative characters and curative effect of total hip arthroplasty(THA)in treatment of acetabular fractures combined with ipsilateral femoral head or neck fractures.Methods One stage THA was done in seven patients with acetabular fractures combined with ipsilateral femoral head fracture(one patient)or femoral neck fractures(six patients)7-21 days after fractures.There were five males and two females,at age range of 41-65 years(average 50 years).According to AO classification,there were one patient with type A fracture,three with type B and three with type C.Of all,five patients received biological acetabular replacement after reduction and internal fixation of acetabular fracture and two received PMMA acetabular replacement with metal enforcement ring.All patients received biological femoral stem.Results Of all,six patients were followed up for from 2 years and 3 months to 6 years and 5 months(mean 3 years and 9 months),which showed heterotopic ossitlcation in one patient and dislocation in one who recovered after manipulative reduction.The Harris score was

  2. MR arthrography for evaluation of the acetabular labrum

    Petersilge, C.A. [Musculoskeletal and Emergency Radiology, Hillcrest Hospital, Mayfield Heights, OH (United States); Radiology and Orthopedic Surgery, Case Western Reserve Univ., Mayfield Heights, OH (United States)

    2001-08-01

    MR arthrography of the hip has provided new insights into the lesions underlying mechanical hip pain. Until now evaluation of these structures, especially the acetabular labrum, has been limited. With the joint distention provided by MR arthrography, labral detachments and intrasubstance tears can be identified and differentiated from the many varied appearances of the asymptomatic labrum. This article reviews the normal anatomy of the hip, the clinical presentation of internal derangement and the technique for performing MR arthrography. The variations in morphology and signal of the asymptomatic labrum are reviewed as well as the appearance of the abnormal labrum. (orig.)

  3. Quantifying the contribution of pincer deformity to femoro-acetabular impingement using 3D computerised tomography

    Dandachli, Wael; Najefi, Ali; Iranpour, Farhad; Lenihan, Jonathan; Hart, Alister; Cobb, Justin [Imperial College London, Charing Cross Hospital, Department of Orthopaedic Surgery, London (United Kingdom)

    2012-10-15

    To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48 vs 37 , p < 0.001; and 216 vs 176 , p < 0.0001 respectively). Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190 suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190 may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. (orig.)

  4. Quantifying the contribution of pincer deformity to femoro-acetabular impingement using 3D computerised tomography

    To provide a simple, reliable method for the three-dimensional quantification of pincer-type hip deformity. Computerised tomography scans of 16 normal female hips and 15 female hips with clinical femoro-acetabular impingement (FAI) and radiographic signs of pincer secondary to acetabular protrusio were analysed. After orientating the pelvis in the anterior pelvic plane, the acetabular centre was determined, and the ratios of its coordinates to the corresponding pelvic dimensions were calculated. Acetabular coverage of the femoral head and centre-edge angles were also measured for the two groups. In hips with a pincer, the hip was medialised by 37 % (p = 0.03), more proximal by 5 % (p = 0.05) and more posterior by 9 % (p = 0.03) compared with the normal hips. Coverage of the femoral head in protrusio hips was significantly greater than normal (average 71 % vs 82 %, p = 0.0001). Both the lateral centre-edge angle and the combined anterior-posterior centre-edge angle were greater in protrusio hips than in the normal ones (48 vs 37 , p < 0.001; and 216 vs 176 , p < 0.0001 respectively). Displacement in acetabular protrusio occurs in all planes. This CT-based method allows for the accurate and standardised quantification of the extent of displacement, as well as 3D measurement of femoral head coverage. In the adult female population, a combined centre-edge angle of over 190 suggests an acetabulum that is too deep and a potential cause of symptoms of femoro-acetabular impingement. Conversely, an acetabulum that has a combined centre-edge angle of less than 190 may be considered to be of normal depth, and therefore not contributing a pincer to FAI should it occur. (orig.)

  5. Comparison of acetabular version angle measurements between prone and reformatted supine computed tomography images

    Chong, Le Roy [Changi General Hospital, Department of Radiology, Singapore (Singapore); Too, Chow Wei [Singapore General Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2014-03-15

    To compare acetabular version angle measurements of CT scans in the prone and reformatted supine positions. CT acetabular version angle measurements have previously been done in the prone position to correct for pelvic tilt. With the advent of multidetector CT, recent studies have evaluated acetabular version angles measured in the supine position. To our knowledge, a comparison between these two approaches has not been performed. Case series in which consecutive CT urography studies of 49 adult patients performed in both prone and supine positions were retrospectively reviewed, and acetabular version angles of both hips measured. Retrospective review of 49 consecutive CT urography studies performed in both prone and supine positions was done, and acetabular version angles of both hips were measured. Two radiologists measured the acetabular version angles independently. Multiplanar reformation of the supine CT images was performed to compensate for pelvic tilt and rotation prior to angle measurements. There was excellent interobserver agreement between the two readers (ICC = 0.90). Acetabular version angle measurements from the prone CT images were larger compared to reformatted supine images (24.0 and 21.3 , respectively, p < 0.0001), with greater angles found in women. There was strong correlation between supine and prone acetabular version angle measurements with a Pearson correlation coefficient of 0.743. Acetabular version angles measured from prone and reformatted supine CT images show strong correlation but are significantly different with larger angles obtained from the former and in women; clinical implications of these findings may require further study in other to determine the best method of version angle measurement. CT acetabular version angle measurement is also reliable with excellent interobserver correlation. (orig.)

  6. Vaginal mass following uncemented total hip arthroplasty

    Young-Soo Shin

    2014-01-01

    Full Text Available A 53-year-old woman developed a vaginal mass following an uncemented total hip arthroplasty. The mass was in direct communication with the hip through an acetabular medial wall defect after loosening of the acetabular component. The mass formation was caused simultaneously by changes secondary to polyethylene wear, a tiny delamination of the porous titanium mesh coating and a broken antirotational tab on the acetabular cup, all of which may have served as sources of metal particles. A careful evaluation of the patient′s history, symptoms, X-ray findings and computed tomography scans should always be performed to ensure accurate diagnosis.

  7. Accuracy of the modified Hardinge approach in acetabular positioning

    Goyal, Prateek; Lau, Adrian; McCalden, Richard; Teeter, Matthew G.; Howard, James L.; Lanting, Brent A.

    2016-01-01

    Background The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1–3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone. PMID:27240130

  8. Denervação acetabular cranial e dorsal no tratamento da displasia coxofemoral em cães: 360 dias de evolução de 97 casos Cranial and dorsal acetabular denervation technique in treatment of hip dysplasia in dogs: 360 days evaluation of 97 cases

    Cássio R.A. Ferrigno; Alexandre Schmaedecke; Leda M. de Oliveira; Raquel S. D'Ávila; Estela Y. Yamamoto; João Paulo E. Saut

    2007-01-01

    Realizou-se a pesquisa com o intuito de avaliar os resultados clínicos da denervação acetabular cranial e dorsal por curetagem em cães com displasia coxofemoral. Foram estudados, para tanto, 97 cães, sem predileção racial ou sexual, de 1-7 anos de idade, com diagnóstico clínico e radiográfico de displasia coxofemoral. Para avaliação dos resultados da técnica cirúrgica, de curetagem das fibras nervosas do periósteo acetabular cranial e dorsal, exames clínicos foram realizados no momento pré-op...

  9. The painful hip: new concepts

    Blankenbaker, Donna G.; Tuite, Michael J. [University of Wisconsin Medical School, Department of Radiology, Division of Musculoskeletal Imaging, Madison, WI (United States)

    2006-06-15

    Hip pain is a common condition, and the work-up often includes imaging. This article reviews the normal MR anatomy of the hip and the imaging findings of internal derangements, snapping hip, and femoral acetabular impingement. We will describe the role of MR arthrography in evaluating the patient with suspected labral and articular cartilage abnormalities, as well as the pitfalls in interpretation. We will review the causes of a snapping hip, and the role of sonography in evaluating and guiding treatment of the snapping iliopsoas tendon. We will also review the radiographic and MRI signs of femoroacetabular impingement (FAI), a cause of early degenerative joint disease and hip pain. (orig.)

  10. A Stereophotogrammetric System For The Detection Of Prosthesis Loosening In Total Hip Arthroplasty

    Baumrind, Sheldon; Genant, Harry K.; Hunter, John; Miller, David; Moffitt, Francis; Murray, William R.; Ross, Steven E.

    1980-07-01

    Loosening of the prosthetic device occurs in about 5% of cases following placement of total hip prostheses (THP). Early detection of loosening is much desired but is difficult to achieve using conventional methods. Due to errors of projection, it is quite possible to fail to detect mobility of even as much as 5 mm on single x-ray films. We are attempting to develop a simplified photogrammetric system suitable for general hospital use which could detect loosening of 0.8 mm at the 95 % level of confidence without use of complex stereoplotting equipment. Metal reference markers are placed in the shaft of the femur and in the acetabular region of the pelvis at the time of surgery. The distances between these reference markers and certain unambiguous points on the prostheses are computed analytically using an X-Y acoustical digitizer (accuracy ± 0.1 mm) and software developed previously for craniofacial measurement. Separate stereopairs of the joint region are taken under weight-bearing and nonweight-bearing conditions. Differences in the measured distances between the bo-ne markers and the prosthetic components on the two stereopairs are taken as indicators of prosthesis loosening. Measurements on a phantom using ten different x-ray stereopairs taken from as many different perspectives have established that true linear distances between reference points and prostheses can be measured at the desired reliability with the present low precision system. Preliminary in vivo measurements indicate that the main unresolved problem is the movement of the subject between the two exposures of each single stereopair. Two possible solutions to this problem are discussed.

  11. Computed tomography in abnormalities of the hip

    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip join can be measured by means of computed tomography. (Auth.)

  12. Computed tomography in abnormalities of the hip

    Visser, J.D.; Jonkers, A.; Klasen, H.J. (Rijksuniversiteit Groningen (Netherlands). Academisch Ziekenhuis); Hillen, B. (Rijksuniversiteit Groningen (Netherlands). Lab. voor Anatomie en Embryologie)

    1982-06-26

    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip joint can be measured by means of computed tomography.

  13. A Novel Fixation System for Acetabular Quadrilateral Plate Fracture: A Comparative Biomechanical Study

    Guo-Chun Zha

    2015-01-01

    Full Text Available This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF and pelvic brim long screws fixation (PBSF provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF, L-shaped plate fixation (LPF, and H-shaped plate fixation (HPF; AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head.

  14. Porous surface replacement of the hip with chamfered-cylinder component.

    Amstutz, H; Kilgus, D; Kabo, M; Dorey, F

    1988-01-01

    One hundred porous surface replacements (PSR) were performed in 92 patients (63 men and 29 women) with a mean age of 53 (range 17-76). Follow-up times range from 1 to 4 years, with 48 patients having a follow-up of at least 2 years. Preoperative diagnoses were osteoarthritis (OA) 63, osteonecrosis (ON) 13, dysplasia 9, rheumatoid-ankylosing spondylitis 6, and other 9. Seventeen hips had metal-backed acrylic-fixed THARIES acetabular sockets, nine hips had a porous cobalt chrome hemispheric beaded acetabular component with adjuvant fixation screws and externally protruding screw hubs, and 74 hips had a porous chamfered cylinder-design acetabulum. Pain relief had been immediate and more complete than with acrylic-fixed or biologic-ingrowth stem-type replacement with comparable walking and function improvements. There have been no major systemic complications, sepsis, or loosening. There have been two transient peroneal nerve palsies and three trochanteric fibrous unions. There have been three reoperations, one for subluxation, one for "metalosis" due to mesh pad loosening, and one femoral neck fracture. Examination of one removed femoral surface component which has been histologically sectioned revealed excellent (90%) bone in-growth. Circumferential progressive radiolucencies developed at the bone-cement interface by 1 year in all of the 17 acrylic-fixed acetabular components. Reaming or seating defects were noted in 25% of the ingrowth components on postoperative radiographs. Radiographic analysis of immediate postoperative films of the chamfered cylinder design acetabular components frequently demonstrated bone-component interface radiolucencies which represented component seating defects. These initial interface radiolucencies became progressively more narrow over the first six months postoperatively suggesting "healing" of the reamed bone-component interface with trabecular bone around the chamfered cylinder acetabular components. Partial healing of initial

  15. 髋臼周围旋转截骨术联合髋关节镜治疗中青年髋臼发育不良%TREATMENT OF ADULT DEVELOPMENTAL DYSPLASIA OF THE HIP BY ROTATIONAL ACETABULAR OSTEOTOMY COMBINED WITH DEBRIDEMENT UNDER ARTHROSCOPE

    廉永云; 刘雪峰; 逯代锋; 周勇; 王鲲鹏; 刘全; 周振熙

    2011-01-01

    Objective To evaluate the results of rotational acetabular osteotomy (RAO) combined with debridement under arthroscope in the treatment of adult developmental dysplasia of the hip (DDH). Methods Between April 2002 and August 2007,24 cases (29 hips) of DDH were treated with RAO combined with debridement under arthroscope. There were 2 males (2 hips) and 22 females (27 hips) with an average age of 37.7 years (range, 21-50 years). The locations were the left hip in 7 cases, the right hip in 12 cases, and both hips in 5 cases. The course of hip pain was 8-216 months (median, 30.5 months). According to Crowe DDH classification, there were 24 hips of type I and 5 hips of type II. According to T8nnis hip osteoarthritis classification, there were 20 hips of stage I and 9 hips of stage II. Results The mean operation time was 150 minutes (range, 120-180 minutes); the mean intraoperative blood loss was 600 mL (range, 500-700 mL); and the mean postoperative drainage volume was 200 mL(range, 50-400 mL). All incisions healed by first intention. Twenty-four cases were followed up 4.5 years on average (range, 3-8 years). At last follow-up, daudication disappeared in 16 hips and was improved in 8 hips. The Harris hip score was improved from 79.4 ± 9.8 preoperatively to 95.1 ± 8.6 postoperatively, showing significant difference (t=2.467, P=0.010). The visual analogue scale (VAS) score was improved from 5.1 ± 0.8 preoperatively to 1.1 ± 0.6 postoperatively, showing significant difference (t=2.118, P=0.011). The X-ray films showed union was achieved at 12-16 weeks (mean, 13.5 weeks). There were significant differences in the centre edge angle, Sharp angle, acetabular coverage rate, and acetabulum-head index between preoperation and postoperation (P < 0.05). Twenty hips at Tennis stage I maintained after operation, among 9 hips at Tsnnis stage II, 5 hips was improved to stage I and 4 hips maintained. Conclusion It has a satisfactory result to treat adult DDH by RAO combined with

  16. The diagnostic value of direct CT arthrography using MDCT in the evaluation of acetabular labral tear: with arthroscopic correlation

    Ha, Yong-Chan; Kim, Jae Yoon [Chung-Ang University College of Medicine, Department of Orthopaedic Surgery, Seoul (Korea, Republic of); Choi, Jung-Ah; Lee, Guen Young; Kang, Heung Sik [Seoul National University Bundang Hospital, Departments of Radiology, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam (Korea, Republic of); Lee, Young-Kyun; Koo, Kyung-Hoi [Seoul National University Bundang Hospital, Orthopaedic Surgery, Seoul National University College of Medicine, Seongnam (Korea, Republic of)

    2013-05-15

    The purpose of this study was first, to determine the sensitivity, specificity, and accuracy of MDCT arthrography (CTA) for the diagnosis of acetabular labral tear and sulcus; second, to correlate tear types using the Lage classification system on CTA compared with the arthroscopic classification; and third, to correlate CTA localization with arthroscopic localization. Direct CTA was performed using 16- or 64-slice MDCT in 126 hips (124 patients) who had chronic groin pain and positive impingement test. Images were reviewed and evaluated by two experienced musculoskeletal radiologists preoperatively. CTA findings were compared with arthroscopic findings in 58 hips (56 patients) under consensus by two orthopedic surgeons. Forty-one of the 58 hips were diagnosed as labral tears on CT arthrography. Forty-three of the 58 hips were shown to have a labral tear on arthroscopy. Sensitivity, specificity, and accuracy for detecting labral tear and sulcus by CTA were 90.7%, 86.7%, and 89.7%, and 93.8%, 97.6% and 96.6% respectively for observer 1, and 90.7% and 80.0%, 87.9% and 87.5%, 95.2%, and 93.1 % respectively for observer 2. Thirty-five out of 41 hips (85%) that were diagnosed with labral tear on CTA correlated substantially with arthroscopic Lage classification (kappa coefficient = 0.65). CTA and arthroscopic findings showed similar distribution patterns of the tears with most lesions located in antero- and postero-superior areas (p = 0.013). Direct CT arthrography using MDCT may be a useful diagnostic technique in the detection of acetabular labral tear. (orig.)

  17. Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting

    ZHAI Ji-liang; LIN Jin; JIN Jin; QIAN Wen-wei; WENG Xi-sheng

    2011-01-01

    Background Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.Methods This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky ⅡC, 6 were ⅢA, and 4 were ⅢB. The mean age at the time of surgery was 63.0 years (range, 46-78 years). During revision surgery, a reinforcement ring was implanted in 6patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9-71 months).Results The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit.The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes,debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification,aseptic loosening, or infection.Conclusion Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.

  18. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    van Raaij Jos JAM

    2008-10-01

    Full Text Available Abstract Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: a conventional 28 mm metal-on-polyethylene articulation and a large head metal-on-metal articulation. We hypothesize that the latter arthroplasties show less bone density loss and higher serum metal ion concentrations. We expect equal functional scores, greater range of motion, fewer dislocations, fewer periprosthetic radiolucencies and increased prosthetic survival with the metal-on-metal articulation. Methods A randomized controlled trial will be conducted. Patients to be included suffer from non-inflammatory degenerative joint disease of the hip, are aged between 18 and 80 and are admitted for primary cementless unilateral total hip arthroplasty. Patients in the metal-on-metal group will receive a cementless titanium alloy acetabular component with a cobalt-chromium liner and a cobalt-chromium femoral head varying from 38 to 60 mm. Patients in the metal-on-polyethylene group will receive a cementless titanium alloy acetabular component with a polyethylene liner and a 28 mm cobalt-chromium femoral head. We will assess acetabular bone mineral density by dual energy x-ray absorptiometry (DEXA, serum ion concentrations of cobalt, chromium and titanium, self reported functional status (Oxford hip score, physician reported functional status and range of motion (Harris hip score, number of dislocations and prosthetic survival. Measurements will take place preoperatively, perioperatively, and postoperatively (6 weeks, 1 year, 5 years and 10 years. Discussion

  19. Hip Revision

    Full Text Available Hip Revision Featuring the ZMR® Hip System Tapered Distal Stem Zimmer, Inc. Winfield, Illinois September 3, 2009 Welcome to this OR Live webcast presentation, brought to you by Zimmer. ...

  20. Acetabular stress fractures in military endurance athletes and recruits: incidence and MRI and scintigraphic findings

    Objective: To evaluate the incidence and the MRI and scintigraphic appearance of acetabular stress (fatigue) fractures in military endurance athletes and recruits. Design and patients: One hundred and seventy-eight active duty military endurance trainees with a history of activity-related hip pain were evaluated by both MRI and bone scan over a 2-year period. Patients in the study ranged in age from 17 to 45 years. They had hip pain related to activity and had plain radiographs of the hip and pelvis that were interpreted as normal or equivocal. The study was originally designed to evaluate the MRI and scintigraphic appearance of femoral neck stress fractures. Patients had scintigraphy and a limited MRI examination (coronal imaging only) within 48 h of the bone scan. Twelve patients demonstrated imaging findings compatible with acetabular stress fractures. Results: Stress fractures are common in endurance athletes and in military populations; however, stress fracture of the acetabulum is uncommon. Twelve of 178 patients (6.7%) in our study had imaging findings consistent with acetabular stress fractures. Two patterns were identified. Seven of the 12 (58%) patients had acetabular roof stress fractures. In this group, two cases of bilateral acetabular roof stress fractures were identified, one with a synchronous tensile sided femoral neck stress fracture. The remaining five of 12 (42%) patients had anterior column stress fractures, rarely occurring in isolation, and almost always occurring with inferior pubic ramus stress fracture (4 of 5, or 80%). One case of bilateral anterior column stress fractures was identified without additional sites of injury. Conclusions: Stress fractures are commonplace in military populations, especially endurance trainees. Acetabular stress fractures are rare and therefore unrecognized, but do occur and may be a cause for activity-related hip pain in a small percentage of military endurance athletes and recruits. (orig.)

  1. A three-dimensional finite element model for biomechanical analysis of the hip.

    Chen, Guang-Xing; Yang, Liu; Li, Kai; He, Rui; Yang, Bin; Zhan, Yan; Wang, Zhi-Jun; Yu, Bing-Nin; Jian, Zhe

    2013-11-01

    The objective of this study was to construct a three-dimensional (3D) finite element model of the hip. The images of the hip were obtained from Chinese visible human dataset. The hip model includes acetabular bone, cartilage, labrum, and bone. The cartilage of femoral head was constructed using the AutoCAD and Solidworks software. The hip model was imported into ABAQUS analysis system. The contact surface of the hip joint was meshed. To verify the model, the single leg peak force was loaded, and contact area of the cartilage and labrum of the hip and pressure distribution in these structures were observed. The constructed 3D hip model reflected the real hip anatomy. Further, this model reflected biomechanical behavior similar to previous studies. In conclusion, this 3D finite element hip model avoids the disadvantages of other construction methods, such as imprecision of cartilage construction and the absence of labrum. Further, it provides basic data critical for accurately modeling normal and abnormal loads, and the effects of abnormal loads on the hip. PMID:23504633

  2. The preliminary application of magnetic resonance arthrography in the diagnosis of acetabular labrale tears

    Objective: To investigate the application value of MR arthrography (MRA) in the diagnosis of acetabular lab ral tears. Methods: Fifteen patients with a high degree of suspected acetabular lab ral tears received fluoroscope-guided injection of the contrast media into the hip joint (hip arthrography) and fat-saturated spin-echo T1-weighted images were obtained in the coronal, sagittal, oblique-axial and radial planes. Hip arthroscopy was performed on 12 of them. Results: Lab ral tears which were diagnosed in 11 patients by hip MRA were confirmed at hip arthroscopy. One patient showed no MRA indication of lab ral tear, also showed normal on arthroscopy. Tear in the anterior-superior quadrant 10 cases of 12 joints (12/13), posterior-superior quadrant 1 case of a joint (1/13). In 11 patients who underwent arthroscopy, hip MRA diagnosed 3 (3/13) joints labrale tears in coronal planes, 10 (10/13) joints in sagittal planes and 13 (13/13) labrale tears in axial-oblique and radial planes. In 15 patients with 20 hip joints, 5 cases 6 joints (6/20) with normal acetabular sublabral sulcus were performed. Conclusions: MR arthrography of hip is a reliable method in the diagnosis of acetabular labrale tears. Scanning method should be included fat-saturated spin-echo T1-weighted images in sagittal and oblique-axial planes or sagittal plus radial planes. The diagnosis of torn posterior-inferior quadrant should pay attention to the existence of a normal variation. (authors)

  3. The role of experience level in radiographic evaluation of femoroacetabular impingement and acetabular dysplasia

    Schottel, Patrick C.; Park, Caroline; Chang, Anthony; Knutson, Zakary; Ranawat, Anil S.

    2014-01-01

    Accurate radiographic interpretation is essential for properly diagnosing the etiology of pre-arthritic hip pain such as femoroacetabular impingement (FAI) and acetabular dysplasia (AD); however, radiographic interpretation can be significantly influenced by the observer’s experience level. This study assesses the accuracy and inter- and intraobserver reliability in the radiographic evaluation of FAI and AD based on experience level. Fifty-five patients diagnosed with FAI, AD or normal hip mo...

  4. Patient-specific acetabular shape modelling: comparison among sphere, ellipsoid and conchoid parameterisations.

    Cerveri, Pietro; Manzotti, Alfonso; Baroni, Guido

    2014-04-01

    The shape of the human acetabular cup was commonly represented as a hemisphere, but different geometries and patient-specific shapes have been recently proposed in the literature. Our aim was to test the limits of the sphericity assumption by comparing three different parameterisations, namely the sphere, the ellipsoid and the rotational conchoid. Models of hip surfaces, reconstructed from CT scans taken from Caucasian race cadavers and patients, were automatically processed to extract the acetabular surface. Two separate analyses were carried out on the overall acetabular shape, including both the acetabular fossa and the lunate surface (case A) and acetabular cup represented by the lunate surface only (case B). Nonlinear gradient-based and evolutionary computation approaches were implemented for the fitting process. Minor differences from the three idealised geometries were detected (median values of the fitting errors different from both the ellipsoid (p difference was detected between the ellipsoid and the conchoid for case A. Significance of the difference between ellipsoid and sphere (p difference was detected between the ellipsoid and the conchoid. In conclusion, we synthesise that the morphology of the overall acetabular cup can be parameterised both with an ellipsoid shape and with a conchoid shape as well with superior quality than the simple sphere. Differently, if one considers just the lunate surface, better fitting results are expected when using the ellipsoid. PMID:22789071

  5. Computed tomography measurements of the acetabulum in adult dysplastic hips: Which level is appropriate

    Anda, S.; Kvistad, K.A. (Dept. of Radiology, Trondheim Univ. (Norway)); Terjesen, T. (Dept. of Orthopedic Surgery, Trondheim Univ. (Norway))

    1991-05-01

    A study has been performed to evaluate whether one or several levels are needed with comuted tomography (CT) study to provide sufficient information regarding anteversion and acetabular support to the femoral head. A total of 23 hips in 14 adults with uni- or bilateral congenital hip dysplasia (center-edge angle less than 20deg) were assessed by obtaining 5-mm contiguous CT slices and performing acetabular measurements at four levels. Both anterior and posterior acetabular supports as quantified by the anterior and posterior acetabular sector angles were significantly lower than normal at all levels. The sector angles increased in the proximal cuts, whereas the acetabular anteversin increased caudally. Because no important additional information was gained by measuring at different levels, we conclude that CT study at one level is sufficient for acetabular measurements and suggest that the slice through the center of the femoral head is the most appropriate one. (orig.).

  6. Ability of lower teardrop edge to restore anatomical hip center height in total hip arthroplasty

    Lu Yufeng; Cheng Liming; Guo Wanshou; Yu Qingsheng; Gao Fuqiang; Zhang Qidong; Liu Zhaohui

    2014-01-01

    Background The acetabular teardrop is often used to guide acetabular component placement in total hip arthroplasty (THA).Placing the lower acetabular component aspect at the same level as the lower teardrop edge was assumed to restore the hip center of rotation.Here we radiographically analyzed the relationship between cup center and normal contralateral acetabulum center height on unilateral THA using this placement method.Methods A total of 106 unilateral THA cases with normal contralateral acetabula were reviewed and the vertical and horizontal distances in relation to the lower acetabular teardrop edge from both hip joint centers,cup inclination,and anteversion were measured radiographically.The paired t-test was used to compare left and right hip center heights.Scatter plots and Pearson's correlation coefficients were used to evaluate differences in hip center heights,cup anteversion,inclination angles,and medialized cup center distance compared to the contralateral hip joint.Results Cup center height was significantly greater (P <0.01) than contralateral hip joint center height (93.4% in the 0-5 mm range,6.6% >5 mm).There was a weak correlation between hip center height difference and inclination (r=0.376,P <0.01) and between difference and anteversion (r=0.310,P <0.01) but no correlation between difference and outer cup diameter (r=0.184,P=0.058) or difference and medialized cup center distance (r=-0.098,P=0.318).Conclusions Although this method did not exactly replicate anatomic hip center height,the clinical significance of cup center height and anatomic hip center height differences is negligible.This acetabular component placement method has high simplicity,reliability,and stability.

  7. Examination and treatment of a professional ballet dancer with a suspected acetabular labral tear: A case report.

    Khoo-Summers, Lynnette; Bloom, Nancy J

    2015-08-01

    Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. PMID:25725589

  8. Poor fixation of the Mittelmeier hip prosthesis

    We have evaluated 30 Mittelmeier hips on an average 3.3 years after the operation. Seven hips had been revised because of severe pain and mechanical loosening and one because of fracture of the threaded ceramic cup. Only five of the remaining 22 hips were asymptomatic. There was radiographic migration of the acetabular and femoral components in more than one third of the hips and increased scintimetric values around the femoral component in all but two hips. Unfavorable design of the Mittelmeier prosthesis may be an important etiologic factor contributing to poor component fixation and inferior clinical results. (author)

  9. An unusual mode of failure of a tripolar constrained acetabular liner: a case report.

    Banks, Louisa N

    2012-02-01

    Dislocation after primary total hip arthroplasty (THA) is the most commonly encountered complication and is unpleasant for both the patient and the surgeon. Constrained acetabular components can be used to treat or prevent instability after primary total hip arthroplasty. We present the case of a 42-year-old female with a BMI of 41. At 18 months post-primary THA the patient underwent further revision hip surgery after numerous (more than 20) dislocations. She had a tripolar Trident acetabular cup (Stryker-Howmedica-Osteonics, Rutherford, New Jersey) inserted. Shortly afterwards the unusual mode of failure of the constrained acetabular liner was noted from radiographs in that the inner liner had dissociated from the outer. The reinforcing ring remained intact and in place. We believe that the patient\\'s weight, combined with poor abductor musculature caused excessive demand on the device leading to failure at this interface when the patient flexed forward. Constrained acetabular components are useful implants to treat instability but have been shown to have up to 42% long-term failure rates with problems such as dissociated inserts, dissociated constraining rings and dissociated femoral rings being sited. Sometimes they may be the only option left in difficult cases such as illustrated here, but still unfortunately have the capacity to fail in unusual ways.

  10. Effect of increased pushoff during gait on hip joint forces

    Lewis, Cara L.; Garibay, Erin J.

    2014-01-01

    Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditi...

  11. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Espandar R

    2012-01-01

    Full Text Available Background: One of the difficulties in acetabulum surgery is appropriate exposure of the site of surgery. Trochanteric flip osteotomy is one of the surgical methods for superoposterior and posterior acetabulum exposure. However, due to possible complications some surgeons prefer to avoid this procedure. This study was undertaken to determine the outcome of surgical treatment of acetabular fracture using trochanteric flip osteotomy. Methods : In this prospective cohort study, 14 patients with acetabular fracture who had been admitted in Imam Khomeini Hospital in Tehran, Iran, during 2003-2006 underwent trochanteric flip osteotomy. The patients were followed for at least one year post-surgically. Demographics, radiologic findings, intensity of pain using visual analogue scale (VAS, Harris hip score (HHS, force of hip abductors and complications were noted. Data analysis was performed using SPSS ver. 13.Results : The mean HHS was 82.5 (55-95. Heterotopic ossification was observed in three patients. There were no cases of postoperative infection or nonunion. Only two patients showed displacement of osteotomized fragments. Reduction was anatomic in 10 patients. In one patient, the force of hip abductors was three-fifth. The mean hip pain was 3.4 based on VAS. There were no cases of femoral head osteonecrosis. With respect to HHS, the final hip status was excellent and good in four and six patients, respectively. Three patients had fair and only one patient had poor condition.Conclusion: It seems that trochanteric flip osteotomy has much fewer complications in comparison to other methods justifying its use in such cases.

  12. What is the role of clinical tests and ultrasound in acetabular labral tear diagnostics?

    Troelsen, Anders; Mechlenburg, Inger; Gelineck, John;

    2009-01-01

    . PATIENTS AND METHODS: We examined 18 patients (18 hips, 2 men, median age 43 (32-56) years) with impingement test, FABER test, resisted straight leg raise test, ultrasound, and MR arthrography. They had had previous periacetabular osteotomies due to symptomatic, acetabular dysplasia. All hips showed no or...... only slight signs of osteoarthritis (Tönnis grade 0-1). RESULTS: MR arthrography identified labral tears in 17 of the 18 hips. Ultrasound had a sensitivity of 94%, a positive predictive value of 94%, and was false negative in only 1 case compared to MR arthrography. The impingement test had the best...

  13. Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature

    Chandrasekar Coonoor R

    2010-03-01

    Full Text Available Abstract A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis.

  14. Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature

    Chandrasekar Coonoor R; Neelapala Venkata SS; Grimer Robert J

    2010-01-01

    Abstract A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis.

  15. Revision hip replacement for recurrent Hydatid disease of the pelvis: a case report and review of the literature.

    Neelapala, Venkata S S; Chandrasekar, Coonoor R; Grimer, Robert J

    2010-01-01

    A case of a large recurrent hydatid cyst involving the right ilium and right hip treated with excision of the cyst, Total hip replacement and revision of the acetabular component with a Tripolar articulation for cyst recurrence and acetabular component loosening is presented along with a review of the relevant literature. To our knowledge there is no reported case of Total Hip replacement and revision for hydatid disease involving the bony pelvis. PMID:20222941

  16. Hip dysplasia in the cat: a report of three cases

    Hip dysplasia was diagnosed in three cats. Two were presented with a history of hindlimb lameness and the other had a history of constipation. All were confined for two weeks and showed considerable clinical improvement. At follow-up examination the cats were free of clinical signs despite the deterioration in the radiological appearance of their hips. Luxation or subluxation of the hips, insufficient development of the craniolateral acetabular edges, loss of the arched shape of the cranial subchondral acetabular bones, shallow acetabula and secondary degenerative changes on the femoral heads and necks were the main radiological findings in the affected cats

  17. State-of-the-Art Hip Surgeries for Active Adults

    Full Text Available ... hip joint; that’s the acetabular bone you’re looking at. Again, up is the front of the ... a significantly larger incision. So if you’re looking for a small- incision hip replacement, the last ...

  18. Acetabular labral tears: contrast-enhanced MR imaging under continuous leg traction

    Nishii, T. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Nakanishi, K. [Dept. of Radiology, Osaka Univ. Medical School, Suita (Japan); Sugano, N. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan); Naito, H. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Tamura, S. [Div. of Functional Diagnostic Imaging, Biomedical Research Center, Osaka Univ. Medical School, Suita (Japan); Ochi, T. [Dept. of Orthopaedic Surgery, Osaka Univ. Medical School, Suita (Japan)

    1996-05-01

    The objective of this study was to evaluate the effects of continuous leg traction on contrast-enhanced MR imaging of the hip joint and to determine whether MR imaging under these conditions is useful for demonstrating acetabular labral tears. Nineteen hips underwent MR imaging with a T1-weighted spin-echo sequence, followed by MR imaging under continuous leg traction after intravenous injection of gadolinium-DTPA. Joint fluid enhancement and labral contour detection were evaluated. Eleven hips had labral tears shown by conventional arthrography, arthroscopy and macroscopic surgical findings. Assessment of labral tears by MR imaging was correlated with the diagnosis based on these standard techniques. Joint fluid enhancement was obtained in all hips at 30 min after injection. Superior and inferior labral surfaces were completely delineated in 1 hip on the unenhanced MR images, and in 7 and 13 hips, respectively, on the enhanced images under traction. The enhanced images under traction depicted 9 of the 11 labral tears. Comparison between the unenhanced image and the enhanced image under traction avoided mistaking undercutting of the labrum for a tear in 4 hips. Contrast-enhanced MR imaging under traction was valuable for detecting labral tears non-invasively and without radiation. Follow-up examinations using this method in patients with acetabular dysplasia can help to clarify the natural course of labral disorders and enable better treatment planning. (orig./MG)

  19. Hip Joint Osteochondroma: Systematic Review of the Literature and Report of Three Further Cases

    Asim M. Makhdom

    2014-01-01

    Full Text Available The aim of this study is to systematically review the literature with regards to surgical treatment of patients with hip joint osteochondromas, and to report our surgical management of three paediatric patients who had femoral neck or acetabular osteochondromas in association with acetabular dysplasia. We performed a systematic review using PubMed and Embase databases for all studies that reported surgical treatments for patients with peritrochanteric or acetabular osteochondroma with or without acetabular dysplasia. We also retrospectively reviewed three patients who were diagnosed with a hip osteochondroma in association with actetabular dysplasia. These patients were known to have hereditary multiple exostoses (HME. The systematic review revealed 21 studies that met our inclusion criteria. All studies were case reports and retrospective in nature and failed to conclude a uniform treatment plan. The three reported cases illustrate successful excision of hip osteochondromas and treatment of acetabular dysplasia. Early excision of hip osteochondromas might prevent acetabular dysplasia in HME patients. Routine radiographic pelvic survey at the time of diagnosis of HME is recommended for early detection of hip osteochondromas and acetabular dysplasia in these children.

  20. Increasing thickness and fibrosis of the cartilage in acetabular dysplasia: a rabbit model research

    LI Tian-you; MA Rui-xue

    2010-01-01

    Background The order and mechanism of pathological changes in acetabular dysplasia are still unclear. This study investigated cartilage changes in rabbit acetabular dysplasia models at different ages.Methods Twenty-seven 1-month-old New Zealand rabbits underwent cast immobilization of the left hind limb in knee extension. Serial acetabular dysplasia models were established by assessment of the acetabular index and Sharp's angle on radiographs. The thickness of the acetabular cartilage was measured under a microscope, and fibrosis was observed. Ultrastructural changes were investigated with scanning electron microscopy and transmission electron microscopy. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 were measured by real-time fluorescence quantitative polymerase chain reaction.Results In an immature group of rabbits, the acetabular index of the treated hip increased with animal growth. The cartilage on the brim of the left acetabulum was significantly thicker than that on the right side. The collagen fibrils on the surface of the cartilage became gross, and the chondrocytes in the enlargement layer underwent necrosis. In a mature group of rabbits, the left Sharp's angle increased in the rabbits with 6-week casting. The cartilage on the brim of the left acetabulum underwent fibrosis. The chondrocytes were weakly stained, and the number of lysosomes was much larger than normal. The messenger RNA expression of collagen Ⅰ and Ⅱ, β1 integrin, and caspase-9 in the cartilage differed significantly at different ages.Conclusions Increasing thickness followed by fibrosis may be the order of pathological cartilage changes in acetabular dysplasia, with changes in ultrastructure and collagen expression contributing to the process.

  1. Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear

    Reiman, M P; Goode, A P; Cook, C E;

    2015-01-01

    BACKGROUND: Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent...

  2. Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases of multi-center statistic analysis%髋臼骨折ABC损伤变数定位系统的设计与1122例多中心研究分析

    张春才; 苏佳灿; 曹烈虎; 徐永清; 阮墨; 陈庄洪; 黄继峰; 蔡贤华; 沈惠良; 刘利民; 王继芳; 许硕贵; 王岩; 唐佩福; 梁雨田; 王家让; 王愉思; 王振昊; 刘文德; 李文锐; 李文虎; 王序全; 禹宝庆; 周东生; 张鹏; 王仁; 王刚; 陈育岳; 丛永健; 纪方; 付青格; 刘欣伟; 章云童; 牛云飞; 王攀峰

    2011-01-01

    Objective:To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. Methods: According to acetabular three-column conception, and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint,it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front,dome and posterior mixture acetabular fracture. Lower case English letters a,m,p represented front, dome, posterior fracture, respectively. Acetabular damage variables: 1 was simple displaced fractures; 2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables:α was sacroiliac joints or sacroiliac fracture horizontal separation deflection; β was sacroiliac joints or sacroiliac fracture vertical separation deflection; γwas pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; αβγδ was compound floating damage. Proximal humerus joint damage variables: Ⅰ was femoral head fracture; Ⅱ was femoral neck fracture; Ⅲ was intertrochanteric fractures of femur; Ⅳ was Ⅰ to Ⅲ compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view,ilium and obturator oblique view, and 2/3D-CT materials were analyzed and researched. Results: Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases (20.8%), B in 605 cases (53.1% ), C in 298 cases (26.1%);front column fracture in 808 cases (70.9%), dome fracture in 507 cases (44.5%), posterior fracture in

  3. Acetabular fractures following rugby tackles: a case series

    Morris Seamus

    2011-10-01

    Full Text Available Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting 'the tackle' to only two players may well reduce the likelihood of this life-altering injury.

  4. Acetabular fractures following rugby tackles: a case series

    Good, Daniel W

    2011-10-05

    Abstract Introduction Rugby is the third most popular team contact sport in the world and is increasing in popularity. In 1995, rugby in Europe turned professional, and with this has come an increased rate of injury. Case presentation In a six-month period from July to December, two open reduction and internal fixations of acetabular fractures were performed in young Caucasian men (16 and 24 years old) who sustained their injuries after rugby tackles. Both of these cases are described as well as the biomechanical factors contributing to the fracture and the recovery. Acetabular fractures of the hip during sport are rare occurrences. Conclusion Our recent experience of two cases over a six-month period creates concern that these high-energy injuries may become more frequent as rugby continues to adopt advanced training regimens. Protective equipment is unlikely to reduce the forces imparted across the hip joint; however, limiting \\'the tackle\\' to only two players may well reduce the likelihood of this life-altering injury.

  5. Para-acetabular peritendinitis calcarea; its radiographic manifestations

    Peritendinitis calcarea and os acetabuli have long been confused during interpretations of hip-joint radiographs. Such confusion is reflected in the medical literature. The present study differentiated these two entities according to their interval radiographic progression and regression. There were 137 instances of para-acetabular calcifications among 110 subjects (59 men and 51 women), whose mean age was 46.8 years at the time of their initial detection. Twenty-six of the subjects had lumbago, which was probably unrelated. Other abnormalities including narrowed intervertebral spaces, scoliosis, and spondylolysis were observed in 21 of the subjects. These could have been responsible for any symptoms they had had, but none of the subjects complained of local hip-joint pain when the radiographs in question were made. Ninety-three of these instances of calcification were reviewed by means of serial radiographs. Interval changes in the sizes and shapes of the calcifications occurred among 90 of them, indicative of the latent type of peritendinitis calcarea. No interval changes were noted in the remaining three cases, indicating they were secondary ossification centers; namely, os acetabuli. This study showed that in asymptomatic adults, most para-acetabular calcifications were really not os acetabuli, but actually peritendinitis calcarea. (author)

  6. High-precision measurements of cementless acetabular components using model-based RSA: an experimental study

    Baad-Hansen, Thomas; Kold, Søren; Kaptein, Bart L;

    2007-01-01

    BACKGROUND: In RSA, tantalum markers attached to metal-backed acetabular cups are often difficult to detect on stereo radiographs due to the high density of the metal shell. This results in occlusion of the prosthesis markers and may lead to inconclusive migration results. Within the last few years......, new software systems have been developed to solve this problem. We compared the precision of 3 RSA systems in migration analysis of the acetabular component. MATERIAL AND METHODS: A hemispherical and a non-hemispherical acetabular component were mounted in a phantom. Both acetabular components...... underwent migration analyses with 3 different RSA systems: conventional RSA using tantalum markers, an RSA system using a hemispherical cup algorithm, and a novel model-based RSA system. RESULTS: We found narrow confidence intervals, indicating high precision of the conventional marker system and model...

  7. Gender Differences in Hip Anatomy: Possible Implications for Injury Tolerance in Frontal Collisions

    Wang, Stewart C.; Brede, Chris; Lange, David; Poster, Craig S.; Lange, Aaron W.; Kohoyda-Inglis, Carla; Sochor, Mark R.; Ipaktchi, Kyros; Rowe, Stephen A.; Patel, Smita; Garton, Hugh J

    2004-01-01

    Male occupants in frontal motor vehicle collisions have reduced tolerance for hip fractures than females in similar crashes. We studied 92 adult pelvic CT scans and found significant gender differences in bony pelvic geometry, including acetabular socket depth and femoral head width. Significant differences were also noted in the presentation angle of the acetabular socket to frontal loading. The observed differences provide biomechanical insight into why hip injury tolerance may differ with ...

  8. The diagnostic performance of radiography for detection of osteoarthritis-associated features compared with MRI in hip joints with chronic pain

    To evaluate the diagnostic performance of radiography for the detection of MRI-detected osteoarthritis-associated features in various articular subregions of the hip joint. Forty-four patients with chronic hip pain (mean age, 63.3 ± 9.5 years), who were part of the Hip Osteoarthritis MRI Scoring (HOAMS) cohort, underwent both weight-bearing anteroposterior pelvic radiography and 1.5 T MRI. The HOAMS study was a prospective observational study involving 52 subjects, conducted to develop a semiquantitative MRI scoring system for hip osteoarthritis features. In the present study, eight subjects were excluded because of a lack of radiographic assessment. On radiography, the presence of superior and medial joint space narrowing, superior and inferior acetabular/femoral osteophytes, acetabular subchondral cysts, and bone attrition of femoral head was noted. On MRI, cartilage, osteophytes, subchondral cysts, and bone attrition were evaluated in the corresponding locations. Diagnostic performance of radiography was compared with that of MRI, and the area under curve (AUC) was calculated for each pathological feature. Compared with MRI, radiography provided high specificity (0.76-0.90) but variable sensitivity (0.44-0.78) for diffuse cartilage damage (using JSN as an indirect marker), femoral osteophytes, acetabular subchondral cysts and bone attrition of the femoral head, and a low specificity (0.42 and 0.58) for acetabular osteophytes. The AUC of radiography for detecting overall diffuse cartilage damage, marginal osteophytes, subchondral cysts and bone attrition was 0.76, 0.78, 0.67, and 0.82, respectively. Diagnostic performance of radiography is good for bone attrition, fair for marginal osteophytes and cartilage damage, but poor for subchondral cysts. (orig.)

  9. Can pelvic tilting be ignored in total hip arthroplasty?

    Won Yong Shon

    2014-01-01

    CONCLUSION: The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.

  10. Friction measurement in a hip wear simulator.

    Saikko, Vesa

    2016-05-01

    A torque measurement system was added to a widely used hip wear simulator, the biaxial rocking motion device. With the rotary transducer, the frictional torque about the drive axis of the biaxial rocking motion mechanism was measured. The principle of measuring the torque about the vertical axis above the prosthetic joint, used earlier in commercial biaxial rocking motion simulators, was shown to sense only a minor part of the total frictional torque. With the present method, the total frictional torque of the prosthetic hip was measured. This was shown to consist of the torques about the vertical axis above the joint and about the leaning axis. Femoral heads made from different materials were run against conventional and crosslinked polyethylene acetabular cups in serum lubrication. Regarding the femoral head material and the type of polyethylene, there were no categorical differences in frictional torque with the exception of zirconia heads, with which the lowest values were obtained. Diamond-like carbon coating of the CoCr femoral head did not reduce friction. The friction factor was found to always decrease with increasing load. High wear could increase the frictional torque by 75%. With the present system, friction can be continuously recorded during long wear tests, so the effect of wear on friction with different prosthetic hips can be evaluated. PMID:27160557

  11. Outcome of periacetabular osteotomy for the management of acetabular dysplasia: experience in an academic centre.

    Burke, Neil G

    2011-02-01

    Periacetabular osteotomy (PAO) is a very effective reconstructive procedure for treatment of acetabular dysplasia. An orthopaedic paediatric surgeon and a reconstructive hip arthroplasty surgeon performed this procedure together in the early phase of their learning curve and then performed it individually. The early clinical and radiographic results of 85 consecutive PAOs performed in this academic orthopaedic unit were reviewed. The mean Merle-d\\'Aubigné score increased from 12.4 preoperatively to 16 at follow-up. Pre-operatively 73 hips were anteverted and 12 were neutral or retroverted. The mean angle of Wiberg improved from 5 degrees to 21 degrees (p < 0.0001) in anteverted hips, and from 9 degrees to 30 degrees in neutral or retroverted hips. The mean angle of Lequesne and de Sèze improved from 6 degrees to 35 degrees (p < 0.0001) in anteverted hips, and in neutral or retroverted hips from 9 degrees to 30 degrees (p < 0.0001). The acetabular index improved from 26 degrees to 8 degrees (p < 0.0001) in anteverted hips, and from 21 degrees to 7 degrees (p < 0.0001) in neutral or retroverted hips. Over the 7 year period the blood loss and operative time improved from 2000 ml to 900 ml and 4 hours to 2 hours respectively. Four hips (four patients) required conversion to total hip replacement. The radiographic correction and improved clinical scores are similar to those in previous studies. This study shows a survival rate of 94% at 58 months following periacetabular osteotomy. The learning curve and the early results of this procedure performed in our academic unit are encouraging.

  12. 3-D template simulation system in Total Hip Arthroplasty

    In Total Hip Arthroplastry, 2D template on Plain X-ray is usually used for preoperative planning. But deformity and contracture can cause malposition and measurement error. To reduce those problems, a 3D preoperative simulation system was developed. Three methods were compared in this study. One is to create very accurate AP and ML images which can use for standard 2D template. One is fully 3D preoperative template system using computer graphics. Last one is substantial simulation using stereo-lithography model. 3D geometry data of the bone was made from Helical 3-D CT data. AP and ML surface cutting 3D images of the femur were created using workstation (Advantage Workstation; GE Medical Systems). The extracted 3D geometry was displayed on personal computer using Magics (STL data visualization software), then 3D geometry of the stem was superimposed in it. The full 3D simulation system made it possible to observe the bone and stem geometry from any direction and by any section view. Stereo-lithography model was useful for detailed observation of the femur anatomy. (author)

  13. 骨盆相关数据测量对髋臼发育不良髋臼定位的临床意义%Clinical implication of pelvic measurements on acetabular component location in developmental dysplasia of the hip

    杭柏亚; 曲广运

    2007-01-01

    [目的]通过对中国南方50例单侧髋关节置换患者的全骨盆X线片相关数据的测量与分析,来验证JF Crowe在"Total hip replacement in congenital dislocation and dysplasia of the hip"(J.Bone Joint Surg.Am,1979,61:15-23)一文中提到的"股骨头颈交点与股骨头上缘的垂直距离跟坐骨结节下缘与髂骨最高点的垂直距离的比率是20%"的准确性,进而提出国人髋臼发育不良真臼的正确定位.目前国内外尚无新的报道.[方法]测量股骨头颈交点与股骨头上缘的垂直距离(BC),测量坐骨结节下缘与髂骨最高点的垂直距离(AD),计算BC与AD的比率.[结果]50例样本平均值为20.2%,与Crowe观察的结果吻合,其中女性为19.5%,男性为21.3%.[结论]对于髋臼发育不良或者髋关节发育不良的患者,对于真臼的定位可以按照这个比率进行正确的定位.

  14. Navigated non-image-based positioning of the acetabulum during total hip replacement

    Jenny, Jean-Yves; Boeri, Cyril; Dosch, Jean-Claude; Uscatu, Marius; Ciobanu, Eugen

    2007-01-01

    We tested the hypothesis that the non-image-based navigation system used in our department was able to measure accurately the 3D positioning of the acetabular cup of a total hip replacement (THR) and to increase the accuracy of its implantation during THR. We studied 50 consecutive navigated implantations of a THR and compared the intra-operative measurement of the cup by the navigation system to the post-operative measurement by computed tomography (CT) scan. The mean difference between the ...

  15. CONGENITAL DISLOCATION OF RIGHT HIP JOINT: IMPORTANCE OF DYNAMIC ASSESSMENT

    Pranita viveki; R. G. Viveki

    2014-01-01

    Congenital Dislocation of Hip (CDH), is one of the most common congenital diseases in the orthopedic field. It is also known as Developmental Dysplasia of Hip. The condition can be diagnosed by clinical, ultrasonographic and radiological examination. Here we are reporting two days old male baby with congenital dislocation of right hip joint. The goal of treatment is to obtain a reduction to provide an optimal environment for femoral head and acetabular development. Early diagnosis is the mo...

  16. Management of acetabular fractures: challenging work

    CHEN Zheng-rong; YANG Yi

    2006-01-01

    @@ Acetabular fractures are complex and special intraarticular fractures. For most orthopaedic surgeons management of acetabular fractures is hard and challenging because the fractures are the results of high-energy trauma, and usually accompany with severe associated injuries. In addition, these fractures are uncommon except in a few trauma centers. The number of cases a surgeon can encounter is scarce.

  17. A HYBRID INTRUSION PREVENTION SYSTEM (HIPS FOR WEB DATABASE SECURITY

    Eslam Mohsin Hassib

    2010-07-01

    Full Text Available Web database security is a challenging issue that should be taken into consideration when designing and building business based web applications. Those applications usually include critical processes such as electronic-commerce web applications that include money transfer via visa or master cards. Security is a critical issue in other web based application such as sites for military weapons companies and national security of countries. The main contributionof this paper is to introduce a new web database security model that includes a combination of triple system ; (i Host Identity protocol(HIP in a new authentication method called DSUC (Data Security Unique Code, (ii a strong filtering rules that detects intruders with high accuracy, and (iii a real time monitoring system that employs the Uncertainty Degree Model (UDM using fuzzy sets theory. It was shown that the combination of those three powerful security issues results in very strong security model. Accordingly, the proposed web database security model has the ability to detect and provide a real time prevention of intruder access with high precision. Experimental results have shown that the proposed model introduces satisfactory web database protection levels which reach in some cases to detect and prevent more that 93% of the intruders.

  18. Reconstruction of the Acetabulum in Developmental Dysplasia of the Hip in Total Hip Replacement

    Vasileios Sakellariou

    2014-09-01

    Full Text Available Developmental dysplasia of the hip (DDH or congenital hip dysplasia (CDH is the most prevalent developmental childhood hip disorder. It includes a wide spectrum of hip abnormalities ranging from dysplasia to subluxation and complete dislocation of the hip joint. The natural history of neglected DDH in adults is highly variable. The mean age of onset of symptoms is 34.5 years for dysplastic DDH, 32.5 years for low dislocation, 31.2 years for high dislocation with a false acetabulum, and 46.4 years for high dislocation without a false acetabulum. Thorough understanding of the bony and soft tissue deformities induced by dysplasia is crucial for the success of total hip arthroplasty. It is important to evaluate the existing acetabular deformity three-dimensionally, and customize the correction in accordance with the quantity and location of ace tabular deficiencies. Acetabular reconstruction in patients with DDH is hallenging. Interpretation of published data is difficult and should be done with caution because most series include patients with different types of hip disease. In general, the complication rate associated with THA is higher in patients with hip dysplasia than it is in patients with osteoarthritis. Overall, clinical and functional outcomes following THA in patients hip dysplasia (DDH differ from those treated for primary hip osteoarthritis, possibly due to the lower age and level of activity. Although function scores decline with age, the scores for pain and range of motion presented with a statistically significant improvement in the long-term.

  19. Magnetic resonance imaging findings compared with histological findings of the labrum in hip osteoarthritis

    Patients with disorders such as acetabular dysplasia or femoroacetabular impingement are at risk of developing hip osteoartbritis. Assessment of the cartilage and labrum in the hip joint based on magnetic resonance imaging (MRI) has been challenging because of the low signal-to-noise ratio (SNR) due to its deep location, ball and socket structure, and small volume of those structures compared with the whole joint size. To achieve better imaging assessment, direct MR. arthrography (d-MRA) and other techniques such as T2* mapping, T2 mapping, Tlrho, and delayed gadolinium-enhanced MRI (dGEMRIC) have been developed along with the increasing use of high-field MRI. In patients with no apparent osteoarthritic changes such as joint space narrowing or osteophyte and subchondral cyst formation on radiographs, these techniques can detect early cartilage or labral damage. A recently developed semiquantitative MRI-based scoring system for hip osteoarthritis includes evaluation of the labrum, and its application as a potential therapeutic monitoring tool is anticipated. The labrum shows pathological changes such as macroscopic hypertrophy and histological degeneration in hip osteoartbritis, but the pathological background is not well understood when evaluated by MRI. Kubo et al. compared radial MRI findings with histological changes of the labrum in ll hips with osteoarthritis using 1.5-T MRJ and found that fibrous separation and mucoid deposition occurred in the labrum with a ''diffuse high signal'' or ''obscure'' pattern. However, to the best of our knowledge, no studies have demonstrated a correlation between MRI fmdings and histological evidence of the severity of degeneration of the labrum. We hypothesized that radially reconstructed images of the acetabular labrum acquired by 3-T MRI can depict degenerative changes of the labrum. In this study, we sought to determine the correlation between MRI and histological findings of the

  20. Magnetic resonance imaging findings compared with histological findings of the labrum in hip osteoarthritis

    Kanezaki, Shiho; Nakamura, Shigeru; Matsushita, Takashi [Teikyo University School of Medicine, Department of Orthopaedic Surgery, Itabashi-ku, Tokyo (Japan); Yamamoto, Asako; Osawa, Marie [Teikyo University School of Medicine, Department of Radiology, Itabashi-ku, Tokyo (Japan)

    2015-06-01

    Patients with disorders such as acetabular dysplasia or femoroacetabular impingement are at risk of developing hip osteoartbritis. Assessment of the cartilage and labrum in the hip joint based on magnetic resonance imaging (MRI) has been challenging because of the low signal-to-noise ratio (SNR) due to its deep location, ball and socket structure, and small volume of those structures compared with the whole joint size. To achieve better imaging assessment, direct MR. arthrography (d-MRA) and other techniques such as T2* mapping, T2 mapping, Tlrho, and delayed gadolinium-enhanced MRI (dGEMRIC) have been developed along with the increasing use of high-field MRI. In patients with no apparent osteoarthritic changes such as joint space narrowing or osteophyte and subchondral cyst formation on radiographs, these techniques can detect early cartilage or labral damage. A recently developed semiquantitative MRI-based scoring system for hip osteoarthritis includes evaluation of the labrum, and its application as a potential therapeutic monitoring tool is anticipated. The labrum shows pathological changes such as macroscopic hypertrophy and histological degeneration in hip osteoartbritis, but the pathological background is not well understood when evaluated by MRI. Kubo et al. compared radial MRI findings with histological changes of the labrum in ll hips with osteoarthritis using 1.5-T MRJ and found that fibrous separation and mucoid deposition occurred in the labrum with a ''diffuse high signal'' or ''obscure'' pattern. However, to the best of our knowledge, no studies have demonstrated a correlation between MRI fmdings and histological evidence of the severity of degeneration of the labrum. We hypothesized that radially reconstructed images of the acetabular labrum acquired by 3-T MRI can depict degenerative changes of the labrum. In this study, we sought to determine the correlation between MRI and histological findings of the

  1. Total Hip Prosthesis in Coxarthrosis due to Congenital Dislocation or Subluxation of the Hip

    Aritamur, Ayhan; Cakmak, Mehmet; Taser, Omer

    2004-01-01

    At our clinic, total hip prostheses were adapted in 4 cases with coxarthrosis accompanied by severe acetabular insufficiency due to congenital hip dislocation or Subluxation. For the reconstruction of acetabuler insufficiency, femoral head was employed as graft in compliance with the Harris technique. This technique was realized on the patient in between two stages with the purpose of avoding femoral resection, yet temporary neurologic symptoms appeared posfoperatively in this case of ours. O...

  2. Pemberton technique in congenital hip dislocation

    Cakmak, Mehmet; Cabuk, Mustafa K.; Karamehmetoglu, Mahmut; Taser, Omer; Domanic, Unsal; Hamzaoglu, Azmi

    2004-01-01

    63 hips of 55 cases on when Pemberton osteotomy was performed because of acetabular dysplasia have been examined at the termination of a period of at least 6 months and at most 26 months, with an average of 8 months of following in the Department of Orthopaedics and Traumatology of the Istanbul Medical School. It has been concluded that with Pemberton osteotomy the acetabular index which was found to be 39.5 prior to surgery was reduced to 20.3, and that in 82.5% of cases good results in 12.6...

  3. Editorial Commentary: Risk Factors for Chondral Lesions in the Hip-There Is More to It Than Cam and Pincer.

    Hohmann, Erik

    2016-08-01

    Age has been cited in a recent article as the largest predictor of both chondral and labral lesions in patients with hip dysplasia. But it was not surprising that there is also a direct relation between a small lateral center-edge angle, acetabular head index, and cartilage degeneration and an increased acetabular index and labral tears in patients with hip dysplasia. The severity of the congenital disease determines the severity of the intra-articular lesions. PMID:27495863

  4. An Unusual Combination of Acetabular and Pelvic Fracture: Is This a New Subtype of Acetabular Fracture?

    Reza Tavakoli Darestani

    2013-01-01

    Full Text Available Introduction: Acetabular fractures are a common problem among young males. An acetabular fracture with disruption of the joint surface, if untreated, will rapidly lead to post-traumatic osteoarthritis. Proper reduction and internal fixation depend on accurate classification and the quality of imaging.Case Presentation: We present an unusual form of acetabular fracture, which is not included in the conventional classification (Judet and Letournel ; this occurred in a middle-aged male who was operatively treated without any complications. In this case due to posterior extension of the fracture into the SI joint and concomitant anterior column fracture in the area above the acetabular dome, no portion of the acetabular anterior surface remained connected to the innominate bone.Conclusions: We recognized this type of fracture and treated it similarly to both column fractures. We recommend that the classification of acetabular fractures be modified to include this type of fracture.

  5. Validation of a standardized mapping system of the hip joint for radial MRA sequencing

    Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform. (orig.)

  6. Validation of a standardized mapping system of the hip joint for radial MRA sequencing

    Klenke, Frank M.; Hoffmann, Daniel B.; Cross, Brian J.; Siebenrock, Klaus A. [Bern University Hospital, Department of Orthopedic Surgery, Inselspital, Bern (Switzerland)

    2014-10-14

    Intraarticular gadolinium-enhanced magnetic resonance arthrography (MRA) is commonly applied to characterize morphological disorders of the hip. However, the reproducibility of retrieving anatomic landmarks on MRA scans and their correlation with intraarticular pathologies is unknown. A precise mapping system for the exact localization of hip pathomorphologies with radial MRA sequences is lacking. Therefore, the purpose of the study was the establishment and validation of a reproducible mapping system for radial sequences of hip MRA. Sixty-nine consecutive intraarticular gadolinium-enhanced hip MRAs were evaluated. Radial sequencing consisted of 14 cuts orientated along the axis of the femoral neck. Three orthopedic surgeons read the radial sequences independently. Each MRI was read twice with a minimum interval of 7 days from the first reading. The intra- and inter-observer reliability of the mapping procedure was determined. A clockwise system for hip MRA was established. The teardrop figure served to determine the 6 o'clock position of the acetabulum; the center of the greater trochanter served to determine the 12 o'clock position of the femoral head-neck junction. The intra- and inter-observer ICCs to retrieve the correct 6/12 o'clock positions were 0.906-0.996 and 0.978-0.988, respectively. The established mapping system for radial sequences of hip joint MRA is reproducible and easy to perform. (orig.)

  7. Surgical approach in primary total hip arthroplasty: anatomy, technique and clinical outcomes

    Petis, Stephen; Howard, James L.; Lanting, Brent L.; Vasarhelyi, Edward M.

    2015-01-01

    Total hip arthroplasty (THA) has revolutionized the treatment of hip arthritis. A number of surgical approaches to the hip joint exist, each with unique advantages and disadvantages. The most commonly used approaches include the direct anterior, direct lateral and posterior approaches. A number of technical intricacies allow safe and efficient femoral and acetabular reconstruction when using each approach. Hip dislocation, abductor insufficiency, fracture and nerve injury are complications of...

  8. Exposure of the superior gluteal neurovascular bundle for the safe application of acetabular reinforcement cages in complex revisions.

    Smitham, Peter J; Kosuge, Dennis; Howie, Donald W; Solomon, Lucian B

    2016-05-16

    The posterior approach to the hip is the most common extensile approach used, however exposure is limited superiorly by the superior gluteal neurovascular bundle (SGNB). The extra-pelvic course of the SGNB demonstrates variability between individuals, occasionally located only 1 cm from the acetabular rim. In complex acetabular reconstructions where the application of a reinforcement cage maybe required protecting the SGNB is challenging. The flanges of these cages are designed to sit on the ilium superior to the acetabular rim and to receive screws for fixation. The application of such cages may result in iatrogenic injury to the SGNB by way of forceful retraction or entrapment. We describe a technique that involves exposure and release of the SGNB such that the flanges of cage constructs may be safely applied. PMID:27079287

  9. Actis Total Hip System 2 Year Follow-up

    2016-08-09

    Osteoarthritis; Traumatic Arthritis; Rheumatoid Arthritis; Congenital Hip Dysplasia; Avascular Necrosis of the Femoral Head; Acute Traumatic Fracture of the Femoral Head or Neck; Certain Cases of Ankylosis; Non-union of Femoral Neck Fractures; Certain High Sub-Capital and Femoral Neck Fractures in the Elderly

  10. Custom acetabular component design with interactive two-dimensional CT

    This paper reports on a revision of failed acetabular components that must accommodate existing segmental and cavitary bone defects and global loss of bone stock. Two-dimensional CT can be used to determine which patients may benefit from a custom acetabulum and to design such a prosthesis. Ninety-one sequential failed hip arthroplasties were reviewed to find 12 potential custom cup candidates, of whom seven underwent CT assessment and subsequent cup design and placement. Coronal and sagittal CT was used to review existing bone stock and bone defects, to measure and map the contour of the defect into which the new cup must fit and to determine the precise placement, angulation, and depth of screw holes to provide purchase for the new cup. A template was produced for approval, followed by cup manufacture and placement

  11. Computerized tomography in evaluation of decreased acetabular and femoral anteversion

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.)

  12. Radiologic analysis of femoral acetabular impingement: from radiography to MRI

    Dwek, Jerry R. [University of California at San Diego, Department of Radiology, Rady Children' s Hospital and Health Center, San Diego, CA (United States); San Diego Imaging, San Diego, CA (United States); Monazzam, Shafagh [Rady Children' s Hospital and Health Center, Department of Orthopedics, San Diego, CA (United States); Chung, Christine B. [University of California at San Diego, Department of Radiology, San Diego, CA (United States)

    2013-03-15

    Femoral acetabular impingement is a set of morphologic abnormalities that are considered to be a major cause of degenerative disease in the hip joint. Early changes are already present in adolescence when it is the pediatric radiologist who must assess current damage with the aim of averting progression to more severe and debilitating osteoarthritis. A multimodality approach is used for diagnosis, that includes conventional radiography and CT to assess the osseous structures. MR arthrography is the primary advanced imaging modality for assessment of morphologic changes as well as injuries of the labrum and articular cartilage. Details of radiologic imaging are offered to guide the radiologist and provide an avenue for the accurate description of the osseous and articular alterations and injury. (orig.)

  13. Results of Chiari pelvic osteotomy for acetabular dysplasia in adults

    In an attempt to determine indications of Chiari pelvic osteotomy in acetabular dysplasia, postoperative outcome of hip joint (64 joints) was examined on the basis of findings of bone scintigraphy. The subjects were 61 patients with osteoarthrosis of hip joint who underwent preoperative bone scintigraphy. The follow-up period ranged from 2 years to 9 years and 7 months with a mean of 4 years and 9 months. According to X-ray findings, 37 osteoarthrosis joints were staged as early and 27 as progressive. Preoperative bone scintigraphic findings fell into three: (I) normal or slight hot type (33 joints), (II) hot type at the weighting part (16 joints), and (III) double hot type in the weighting part and inside part (15 joints). None of the patients had severe surgical complications such as deep-seated infection, neuroparalysis and pseudojoint. According to the clinical staging for hip joint function, 7 (47%) of 64 joints were judged as poor after osteotomy, belonging to type III. Deterioration of osteoarthrosis was seen in 11 joints (41%) on X-ray films. Of these, 9 had type III. In conclusion, Chiari pelvic osteotomy should not be indicated when type III is shown on bone scintigrams. (N.K.)

  14. Total hip arthroplasty with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis

    吴立东; 金礼斌; 严世贵; 杨泉森; 戴雪松; 王祥华

    2004-01-01

    Objective:To evaluate the outcome of total hip arthroplasty (THA) with cementless cups and femoral head autografts for patients with hip dysplasia and osteoarthritis.Methods: Between 1995 and 2002, we implanted 23cementless cups and femoral head autografts in 20 patients with hip dysplasia and osteoarthritis. In this study, a retrospective study was made on 21 hips in 20 patients (18females and 2 males, aged 50 years on an average) with developmental hip dysplasia treated by THA with acementless cup and femoral head autograft. The acetabular cup was placed at the level of the true acetabuinm and all the patients required autogenous femoral head grafts due to acetabular deficiency. The average rate of the acetabular cup covered by the femoral head autograft was 31%(ranging from 10% to 45%). Eight hips had less than 25%cup coverage and thirteen between 25% and 50%. The average follow-up period was 4.7 years (range, 1-8 years).The replacing outcome was evaluated by modified Harris hip score. Preoperative and follow-up radiographs were made.Results: All the autografts were united to the host bones. No autograft was collapsed or no component from the hip was loosed in all the patients. According to the modified Harris hip score, the average hip score increased from 46 before operation to 89 at the final review. Before operation, the leg-length discrepancy was greater than 2 cm in all the patients except one with bilateral hip dysplasia.After operation, only 2 out of 20 patients had a leg-length discrepancy greater than 1 cm. Three hips showed minor bone resorption in the lateral portion of the graft, which did not support the cup. Three hips developed Grade 1Brooker heterotopic ossification and one developed Grade 2.Conclusions: THA with a cementless cup and a femoral head autograft for patients with osteoarthritis resulted from hip dysplasia can result in favorable outcomes. This method can provide reliable acetabular fixation and restore the acetabular bone stock in

  15. Taper Hip Prosthesis

    Full Text Available ... OR Live" Webcast on the Kinectiv Total Hip System. At this time, let’s join Dr. Maltry in ... going to be installing the Zimmer Kinectiv Hip System today and we'll walk you through that. ...

  16. Wear of highly crosslinked polyethylene acetabular components

    Callary, Stuart A.; Solomon, Lucian B; Holubowycz, Oksana T; Campbell, David G; Munn, Zachary; Howie, Donald W.

    2015-01-01

    Background and purpose Wear rates of highly crosslinked polyethylene (XLPE) acetabular components have varied considerably between different published studies. This variation is in part due to the different techniques used to measure wear and to the errors inherent in measuring the relatively low amounts of wear in XLPE bearings. We undertook a scoping review of studies that have examined the in vivo wear of XLPE acetabular components using the most sensitive method available, radiostereometr...

  17. Clinical and radiological evaluation of hybrid hip replacement in various disorders of hip

    Dhaon B

    2005-01-01

    Full Text Available Background: High rates of loosening of cemented implants led to change in technique of fixation of the implant. Methods: Fifty-nine hips were operated in 42 patients with non-cemented acetabular and cemented femoral components between January 1999 and July 2003. The average age of the patient was 45.2 years in our study. Preoperative diagnosis was avascular necrosis (28, ankylosing spondylitis (18, fracture neck femur (9, rheumatoid arthritis (2 and osteoarthritis (2. Results: At an average follow up of 3.6 years (range 1.2-5.8 years excellent to good results were obtained 92% according to Harris hip criteria. No radiological loosening was noted in any femoral or acetabular component on follow up. One poor result was seen in a case of bilateral ankylosing spondylitis operated on one side. Conclusion: Hybrid THA provides a viable and highly acceptable method of treatment of diseases of hip in young patients.

  18. Wear analysis by applying a pin-disc configuration to phemoral head and acetabular cup Análisis del desgaste de la articulación cabeza femoral–copa acetabular mediante simulación experimental con máquina perno-disco

    Beltrán-Fernandez Juan Alfonso

    2008-07-01

    Full Text Available This work determines a prosthetic hip system’s life-span, focusing on a Mexican phenotype. The total sliding equivalent distance for the system was determined, as well as the loading regime under which the femoral component and the acetabular cup were subjected in normal operating conditions. An experimental tribology essay was then performed to simulate the wearing of the components in a Pin over Disc machine. This assay (for which the test specimens were manufactured in medical grade stainless steel AISI-ASTM 316L for the femoral component and high density polyethylene for the acetabular cup was aimed at simulating wear conditions involved in 10 years of continuous operation. A numerical simulation of operational conditions (using the finite element method was performedIn for establishing assay loading conditions to accurately determine where the loads should be applied. The tribology assay led to quantifying the volumetric loss of materials for the system being analysed. It can be concluded that the methodology proposed in this work for estimating the life-span of a prosthetic hip system was valid and accurate by comparing the results with those found in the literature. A statistical validation of the proposed method is plaaned for the future. Key words: Design life; femoral component; acetabular cup; Mexican phenotype; pin-disc configuration.Este trabajo presenta un estudio que permite establecer la vida útil esperada de un sistema prostético de cadera para el caso del fenotipo mexicano. En primera instancia se determinó la distancia total equivalente de deslizamiento y las condiciones de carga entre el componente femoral y la copa acetabular bajo condiciones normales de carga. Posteriormente, se desarrolló una simulación experimental para la realización de un ensayo tribológico en una máquina de desgaste del tipo Perno sobre Disco (Pin on Disk, POD. Este ensayo sometió al conjunto fabricado en acero inoxidable AISI

  19. Progression of Hip Displacement during Radiographic Surveillance in Patients with Cerebral Palsy.

    Park, Jae Young; Choi, Young; Cho, Byung Chae; Moon, Sang Young; Chung, Chin Youb; Lee, Kyoung Min; Sung, Ki Hyuk; Kwon, Soon-Sun; Park, Moon Seok

    2016-07-01

    Progression of hip displacement is common in patients with cerebral palsy (CP). We aimed to investigate the rate of progression of hip displacement in patients with CP by assessing changes in radiographic indices according to Gross Motor Function Classification System (GMFCS) level during hip surveillance. We analyzed the medical records of patients with CP aged < 20 years who underwent at least 6 months interval of serial hip radiographs before any surgical hip intervention, including reconstructive surgery. After panel consensus and reliability testing, radiographic measurements of migration percentage (MP), neck-shaft angle (NSA), acetabular index (AI), and pelvic obliquity (PO) were obtained during hip surveillance. For each GMFCS level, annual changes in radiographic indices were analyzed and adjusted for affecting factors, such as sex, laterality, and type of CP. A total of 197 patients were included in this study, and 1,097 radiographs were evaluated. GMFCS classifications were as follows: 100 patients were level I-III, 48 were level IV, and 49 were level V. MP increased significantly over the duration of hip surveillance in patients with GMFCS levels I-III, IV, and V by 0.3%/year (P < 0.001), 1.9%/year (P < 0.001), and 6.2%/year (P < 0.001), respectively. In patients with GMFCS level IV, NSA increased significantly by 3.4°/year (P < 0.001). Our results suggest that periodic monitoring and radiographic hip surveillance is warranted for patients with CP, especially those with GMFCS level IV or V. Furthermore, physicians can predict and inform parents or caregivers regarding the progression of hip displacement in patients with CP. PMID:27366015

  20. Clinical and radiographic results of total hip arthroplasty in dogs: 96 cases (1986-1992)

    Results of total hip arthroplasty in 84 dogs (96 hips) were evaluated. Eight (9.5% of) the 84 dogs developed 1 or move complications after total hip arthroplasty. Complications resolved or were corrected in 4 of the dogs; all 4 ultimately achieved good or excellent hip function. Complications necessitated removal of the Prosthesis in the other 4 dogs; 3 ultimately achieved fair hip function and 1 had only poor hip function. Therefore, after resolution of complications, 96% of the hips had good or excellent function. Force plate analysis was performed on 6 dogs with excellent hip function; peak vertical force for the limb that had been operated on was greater than or equal to peak vertical force for the contralateral limb. Radiographically, a radiolucent zone was visible around the acetabular component in 89% of the hips and around the femoral component in 26%. The radiolucent zone around the acetabular and femoral components widened in 14% (6 of 43) and 27% (3 of 11), respectively, of the hips with adequate radiographic follow-up. Aseptic loosening of the acetabular component developed in 3 (3%) of 96 hips, one was successfully revised. Aseptic loosening of the femoral component was not apparent in any of the dogs in this study. Other complications included femoral fracture (n = 3), neurapraxia (3), luxation(1), and unexplained lameness that required implant removal (1). None of the dogs had evidence of wound infection

  1. Prevalence of malformations of the hip joint and their relationship to sex, groin pain, and risk of osteoarthritis: a population-based survey

    Gosvig, Kasper Kjaerulf; Jacobsen, Steffen; Sonne-Holm, Stig;

    2010-01-01

    deformity (risk ratio, 2.2). Acetabular dysplasia and the subject's sex were not found to be significant risk factors for the development of hip osteoarthritis (p = 0.053 and p = 0.063, respectively). The prevalence of hip osteoarthritis was 9.5% in men and 11.2% in women. The prevalence of concomitant...... the county of Østerbro, Copenhagen, Denmark. The inclusion criteria for this study were met by 1332 men and 2288 women. On the basis of radiographic criteria, the hips were categorized as being without malformations or as having an abnormality consisting of a deep acetabular socket, a pistol grip...... deformity, or a combination of a deep acetabular socket and a pistol grip deformity. Hip osteoarthritis was defined radiographically as a minimum joint-space width of 0.13). A deep acetabular socket was a significant risk factor for the development of osteoarthritis (risk ratio, 2.4), as was a pistol grip...

  2. Thin-Walled Cross-Linked Acetabular Liners Need Not Exhibit Reduced Locking Strength.

    Murtha, Andrew S; Roy, Marcel E; Whiteside, Leo A; Tilden, David S; Schmitt, Krystal L

    2015-08-01

    Use of larger diameter femoral heads has emerged as a promising strategy to reduce the risk of dislocation after total hip arthroplasty, but thinning the walls of cross-linked ultra-high-molecular-weight polyethylene (UHMWPE) acetabular liners to accommodate these larger heads may compromise the locking mechanism of the liner. The purpose of this study was to test the mechanical integrity of the locking mechanism in cross-linked and re-melted UHMWPE acetabular components with reduced wall thickness. The locking mechanism of cross-linked (100 kGy/re-melted) acetabular liners in sizes 50/28, 50/36, and 52/36 mm of 1 design was evaluated by lever-out tests and torsion tests. Torsion tests were performed at 2 angles to isolate the liner's locking tabs independent of the contribution of its central post. Lever-out testing demonstrated nominally reduced failure strength in 50/36-mm liners (13.3 N · m) compared with 50/28-mm liners (12.3 N · m; P=.0502), whereas the lever-out strength of 52/36-mm liners was 12.2±0.94 N · m. Failure torques were similar between 50/28- and 50/36-mm liners at 45° and 90°, but the failure torque of size 52/36-mm liners was significantly higher at each angle. The use of larger diameter femoral heads does not compromise the locking mechanism of thinned MicroSeal (Signal Medical Corp, Marysville, Michigan) acetabular liners. Use of a cross-linked UHMWPE acetabular liner, with a locking mechanism that is not compromised when the liner is thinned to a thickness of at least 2.86 mm, appears to be a biomechanically sound construct when articulated with large diameter femoral heads. PMID:26270761

  3. Impaction Grafting for Acetabular Deficiency in Total Hip Arthroplasty for Congenital Hip Dysplasia: A Surgical Technique%加压植骨技术在先天性髋关节发育不良患者全髋置换术中修复髋臼缺损的应用

    毛新展; 赵耀超; Sujoy Roychowdhury; Ross W Crawford

    2013-01-01

    目的 介绍加压植骨技术在先天性髋关节发育不良(congenital hip dysplasia,CDH)全髋关节置换术中修复髋臼缺损的应用,并对其临床早期效果进行评估. 方法 2012年8月~2013年5月我院对15例(15髋)CDH患者施行该术式.对患者手术前后X线结果进行分析,应用Harris评分评价手术前后髋关节功能. 结果 本组患者术前患髋Harris评分平均为(45.2±10.6)分,术后3月随访提高到(81.1±16.5)分,术后未出现感染、脱位等早期并发症. 结论 通过联合应用加压植骨、钛网固定及骨水泥加压技术,患者髋臼形态得以重建,术后恢复良好.多种技术的联合应用在CDH患者全髋置换术中具有重要意义.%Objective To introduce a surgical technique incorporating the impaction bone graft,mesh and cemented technique to reconstruct hip center for congenital hip dysplasia (CHD) patients and reveal some tips of the technique for the severe deficiency of the acetabulum.Methods All 15 CHD patients were performed total hip arthroplasty(THA) combining the impaction bone graft,mesh and cemented technique.The detail of the surgery was compared by the X-ray results of the pre-and post-operation.Then the hip functions were assessed according to Harris score.Results The Harris scores of the patients were increased from average 45.2 ± 10.6 to average 81.1 ± 16.5.No early complications such as infection or dislocation were found after the surgery.Conclusion The technique incorporating the impaction bone graft,mesh and cemented technique should be regarded as a valuable alternative in THA for CHD.

  4. MRI of the hip joint

    Magnetic resonance imaging (MRI) is performed to diagnose many pathologic conditions affecting the hip joint. Either conventional MRI (without contrast enhancement of the joint cavity) or MR arthrography is used to detect and most accurately differentiate hip joint pathologies. Conventional MRI is performed in cases of bone marrow edema, necrosis, arthrosis and especially the so-called ''activated arthrosis'', as well as in inflammatory and tumorous entities. MR arthography, which has only recently become available for use, is excellently suited for diagnosing lesions of the acetabular labrum, cartilage lesions, and free articular bodies. This article provides an overview about MRI characteristics and their accuracy of hip joint diseases and the impact on the therapeutic procedure. (orig.)

  5. Pelvic orientation and assessment of hip dysplasia in adults

    Jacobsen, Steffen; Sonne-Holm, Stig; Lund, Bjarne;

    2004-01-01

    on the measurements of radiographic indices of hip dysplasia. MATERIAL AND METHODS: We investigated the effect of varying pelvic orientation on radiographic measurements of acetabular dysplasia using a cadaver model. Results from the cadaver study were used to validate the radiographic assessments of acetabular...... radiograph was recorded at each 3 degrees increment. The most widely used radiographic parameters of hip dysplasia were assessed. 2) Critical limits of acceptable rotation and inclination/reclination of pelvises were determined on 4151 standing, standardised pelvic radiographs of the CCHS cohort. RESULTS......BACKGROUND: The study was performed to qualify the source material of 4151 pelvic radiographs for the research into the relationship between unrecognised childhood hip disorders and the development of hip osteoarthrosis, and to investigate the effect of varying degrees of pelvic tilt and rotation...

  6. Systemic Inflammatory Responses and Lung Injury following Hip Fracture Surgery Increases Susceptibility to Infection in Aged Rats

    Hao Zhang; Tiansheng Sun; Zhi Liu; Jianzheng Zhang; Xiaowei Wang; Jia Liu

    2013-01-01

    Pulmonary infections frequently occur following hip fracture surgery in aged patients. However, the underlying reasons are not fully understood. The present study investigates the systemic inflammatory response and pulmonary conditions following hip fracture surgery as a means of identifying risk factors for lung infections using an aged rodent model. Aged, male Sprague-Dawley rats (8 animals per group) underwent a sham procedure or hip fracture plus femoral intramedullary pinning. Animals we...

  7. State-of-the-Art Hip Surgeries for Active Adults

    Full Text Available ... in this case it’s going to be a plastic or cross-linked polyethylene bearing. There’s different types ... a longer-lasting hip replacement. So that’s the plastic bearing which is snapped into that acetabular component. ...

  8. Evaluation of the hip joint by computed tomography and ultrasonography

    In patients with dysplastic hips the acetabular angles and femoral anteversion were determined in a CT investigation. Comparative investigations of femoral anteversion were made by ultrasonography and biomedical radiography. The investigations are described and the general conclusions discussed. 205 refs., 15 figs., 10 tabs

  9. Initial stability of cementless acetabular cups: press-fit and screw fixation interaction—an in vitro biomechanical study

    Tabata, Tomonori; Kaku, Nobuhiro; Hara, Katsutoshi; Tsumura, Hiroshi

    2014-01-01

    Background Press-fit and screw fixation are important technical factors to achieve initial stability of a cementless acetabular cup for good clinical results of total hip arthroplasty. However, how these factors affect one another in initial cup fixation remains unclear. Therefore, this study aimed to evaluate the mutual influence between press-fit and screw fixation on initial cup stability. Methods Foam bone was subjected to exact hemispherical-shape machining to diameters of 48, 48.5 and 4...

  10. Hip Revision

    Full Text Available ... you can see this Kershner rod covered in antibiotic loaded PMMA to kind of maintain some endosteal ... On the acetabular side, he's again placed some antibiotic loaded PMMA, which again helps to basically fill ...

  11. Hip Revision

    Full Text Available ... in the radiographic appearance of that acetabular shell. It's become much more vertical. You can see there's ... that cup, and obviously the concern is that it's loose. On the femoral side, if anything, we ...

  12. Zweymuller系统全髋关节置换术治疗髋臼发育不良的中期疗效分析%Metaphase outcome of total hip arthroplasty with Zweymuller system in treating developmental dysplasia of the hip(DDH)

    翁文杰; 邱旭升; 张海林; 袁涛; 陈东阳; 徐志宏; 蒋青

    2011-01-01

    目的:评价Zweymuller螺旋臼结合髋臼加深技术治疗髋臼发育不良的中期疗效.方法:自1998年1月至2004年12月,采用Zweymuller系统进行全髋关节置换术治疗髋臼发育不良继发髋关节骨性关节炎患者56例62髋,男14例(15髋),女42例(47髋);平均年龄48.6岁(30~67岁).术前所有患者均有髋关节疼痛和功能障碍.观察项目包括术后并发症、影像学及功能恢复情况.髋关节功能采用Harris评分标准进行评定.结果:56例获得随访,时间5~11年,平均6.5年.X线检查显示髋臼假体位于真臼住置,与周围骨床结合紧密.髋臼假体外展角35°~50°,股骨假体内、外翻3°以内,术后患肢短缩平均(0.5±0.2)cm.术后近期发生深静脉血栓20例,予溶栓治疗后好转.近期脱位1例,复位、制动3周后下地行走.4髋发生异位骨化、均为BrookⅡ型.无感染、神经损伤病例发生.术后Harris评分(87.4±3.5)分,与术前(43.2±6.7)分比较,差异有统计学意义(P<0.01).结论:Zweymuller螺旋臼结合髋臼加深技术治疗髋臼发育不良继发髋关节骨性关节炎中期疗效优良.%Objective :To analyze the metaphase outcome of total hip arthroplasty with Zweymuller system and deepening acetabulum technique in treating DDH. Methods:From Jan. 1998 to Dec.2004,56 patients (62 hips) with DDH (secondary osteoarthritis) were treated with total hip arthroplasty with Zweymuller system. There were 14 males ( 15 hips ) and 42 females (47 hips) with an average age of 48.6 years,ranged from 30 to 67 years. All patients had pain of hip joint and functional disturbance before operation. Observation items included postoperative complications,imaging and function of hip joint. The function of hip joint was analyzed according to Harris scoring. Results:All patients were followed up from 5 to 11 years with an average of 6.5 years. X-rays showed that the acetabular cup was in the position of true acetabulum,which combined tightly with the

  13. INFLUENCE OF VARIOUS METHODS OF POSTOPERATIVE ANESTHESIA ON THE STATUS OF HAEMOSTASIS SYSTEM IN HIP REPLACEMENT

    V. V. Borin

    2015-12-01

    Full Text Available 120 patients were examined using instrumental methods, such as hemocoagulography and agregatography. It has been various methods of postoperative anesthesia have different effect on the functional status of haemostasis system following hip replacement. Optimization of postoperative anesthesia provides a way of preventing thrombohemorrhagic complications 

  14. Surgical treatment for complicated acetabular fractures

    Ning An; Yang Yanmin

    2004-01-01

    Objective: To sum up the surgical approaches and clinical outcome of complicated acetabular fractures. Methods: 17 patients with complicated acetabular fractures (including 4 cases of transverse with posterior wall fractures, 7 cases of posterior column and wall fractures, 4 cases of anterior and posterior columns fractures, 1 cases of T-type fracture and 1 cases of anterior column with posterior hemitransverse fractures) underwent open reduction and internal fixation with screws and plates by Kocher-Langenbeck (8 cases), ilio-inguinal (2 cases), extended iliofemoral (4 cases) or ilio-inguinal combined with K-L approaches (3 cases). Results: 12 patients with anatomical reduction, 4 patients with satisfactory reduction and 1 patient with non-satisfactory reduction. 15 out of 17 cases were followed up for 6 months to 5 years, and the excellent and good rate was 70.5%. Conclusion: Surgical treatment for complicated acetabular fractures can get a satisfactory reduction and a good clinical outcome.

  15. Assessment of adult hip dysplasia and the outcome of surgical treatment.

    Troelsen, Anders

    2012-06-01

    Hip dysplasia and hip joint deformities in general are recognized as possible precursors of osteoarthritic development. Early and correct identification of hip dysplasia is important in order to offer timely joint preserving treatment. In the contemporary literature, several controversies exist, and some of these were the focus of this doctoral thesis. Categorized into subjects, the major findings and their possible importance are listed below. DIAGNOSTIC ASSESSMENT OF HIP DYSPLASIA: A multi-observer study quantified the variability of different methods for diagnostic assessment of hip dysplasia and osteoarthritis and resulted in general recommendations regarding diagnostic assessment of hip dysplasia. Pelvic tilt was shown to differ significantly between the supine and weight-bearing positions in patients with dysplastic hip joints. This is a finding that adds controversy to the application of neutral pelvic positioning during assessment of hip deformities because pelvic tilt affects the appearance of acetabular version. Weight-bearing assessment of acetabular version showed the presence of retroversion in 33% of dysplastic hips. The establishment of retroversion as a rather frequent entity in dysplastic hips is contradictory to the historical finding that hip dysplasia is characterized by insufficient anterior and lateral coverage. In general, the findings have important implications for orthopedic surgeons and radiologists dealing with diagnostic assessment of painful hips in young adults, and for surgeons planning and performing joint-preserving periacetabular osteotomies. ASSESSMENT OF ACETABULAR LABRAL TEARS IN HIP DYSPLASIA: The roles of ultrasound and clinical tests in acetabular labral tear diagnostics were established. After overcoming an initial learning curve, ultrasound investigation was highly reliable in diagnosing labral tears, whereas only a positive impingement or FABER test was reliable in identifying a labral tear. It seems that non-invasive and

  16. Vascular injuries during total hip revision

    Although most patients undergoing a revision total hip replacement (THR) will have an uneventful procedure, in others the potential of serous vascular injuries is real. Migrating prosthesis or excessive cement may be in compromising positions adjacent or adherent to vessels and pose a particular danger at surgery with inadvertent lacerations of vessels such as the internal and external iliac arteries. In out study of 20 patients with THR, CT with two-dimensional reconstructions is used to define vessel position. In eight of these patients, the hip prosthesis or displaced cement lies within 5 mm of major vessels. In patients with dislocation of the acetabular cup, the potential of vascular injury is highest

  17. Iliac redirectional osteotomy of the acetabular without use of bony implant

    The objective is to value the results of an original redirectional acetabular osteotomy, devised by its senior author. We describe 20 patients with hip developmental dysplasia (14 females and 6 males). The surgical approach is similar to the original description for Salter's osteotomy. The ilium cut buy a gigli saw, is performed in a curved fashion along the bone's coronal plane starting in the greater sciatic notch directed toward the anterior inferior iliac spine. The acetabolum is displaced anterior, lateral and caudally and the osteotomy is fixed with k-wires or screws, according to bone volume and quality, without graft interposition. The patient is immobilized in a spica cast for four to six weeks. Solid bone union was documented in all patients at the six-week follow up. The mean acetabular index correction obtained was measured at six weeks (16 degrades) and at six months (13 degrades). Initial femoral epiphysis extrusion was 25% and there was none at the six-month follow up. At two year later developmental displasia was not documented. This iliac redirectional osteotomy appears as a safe procedure, providing stability and contact for bone union and assures an adequate correction of the pre operative acetabular index and femoral head extrusion. Besides, this technique avoids the risk of graft collapse as in the original Salter's osteotomy

  18. Outcome of operative treatment of acetabular fractures: short term follow-up

    Fractures of the acetabulum result from high energy accidents. The anatomic location of the acetabulum, as well as the three-dimensional structure of the bone, makes the treatment of these injuries extremely challenging. The objective of this study was to determine the outcome of operative treatment of acetabulum fractures with one year follow-up. Methods: In this descriptive case series, 31 patients with acetabular fracture were admitted in North West General Hospital, Peshawar, from July 2010 to Sept 2013. Patients were followed-up till one year. In follow-up, patients were assessed clinically with Merle Aubigne and Postel grading method. Radiological assessment was done using Matta criteria. Results: All patients were male. Twelve (38.7 %) were managed non-operatively, as they fulfilled criteria for non-operative treatment and 19 (61.3%) patients were operated after fulfilling the criteria for internal fixation; they were included for analysis. Ages ranged from 20-60 years with mean age of 37.21 ± 10.07 years. Fourteen (73.7%) patients had anatomic reduction and 5 (26.3 %) patients had imperfect reduction based on Matta radiographic criteria. At 1 year follow-up, we had 16 (84.2 %) excellent hips, 2 (10.5%) good hips and 1 (5.3%) poor hip , based on radiographs; and clinically we had 9 (47.4 %) hips with excellent function, 7 (36.8 %) hips with good outcome, 2 (10.5 %) had fair function and 1 (5.3 %) patient had poor function. Conclusion: Our results show that internal fixation of acetabular fractures lead to good outcome in majority of patients. (author)

  19. Isokinetic performance of hip muscles after revision total hip arthroplasty via previous anterolateral approach.

    Cankaya, Deniz; Aydin, Cemal; Karakus, Dilek; Toprak, Ali; Ozkurt, Bulent; Tabak, Yalçın

    2015-09-01

    We investigated the isokinetic performance of hip muscles and clinical outcomes after revision total hip arthroplasty (THA) via same anterolateral approach used in primary surgery. Thirty patients who had undergone previous THA via an anterolateral approach underwent both acetabular and femoral component revision after aseptic loosening. The Harris Hip Score (HHS) was evaluated during a minimum 2-year follow-up. The isokinetic muscle strength of the operated and nonoperated hips was assessed 1 year after surgery. The HHS improved from 49.0 to 77.4. Operated and nonoperated hips exhibited similar isokinetic performance during all measurements (flexion, extension, and abduction) (p>0.05). This prospective study showed that the anterolateral approach preserves abductor strength after revision THA in aseptic cases with acceptable functional and clinical results. The main clinical relevance of this study is that the same anterolateral approach used in previous primary THA is also safe and viable for revision THA. PMID:26435233

  20. The skill of surface registration in CT-based navigation system for total hip arthroplasty

    Surface registration of the CT-based navigation system, which is a matching between computational and real spatial spaces, is a key step to guarantee the accuracy of navigation. However, it has not been well described how the accuracy is affected by the registration skill of surgeon. Here, we reported the difference of the registration error between eight surgeons with the experience of navigation and six apprentice surgeons. A cadaveric pelvic model with an acetabular cup was made to measure the skill and learning curve of registration. After surface registration, two cup angles (inclination and anteversion) were recorded in the navigation system and the variance of these cup angles in ten trials were compared between the experienced surgeons and apprentices. In addition, we investigated whether the accuracy of registration by the apprentices was improved by visual information on how to take the surface points. The results showed that there was statistically significant difference in the accuracy of registration between the two groups. The accuracy of the second ten trials after getting the visual information showed great improvements. (orig.)

  1. CT to delineate hip pathology in cerebral palsy

    Surgical intervention for cerebral palsy hip dislocation or subluxation is frequently undertaken without a full comprehension of the three-dimensional aspects of the femoral-acetabular complex. CT with a modified technique allows more accurate measurement of the angle of femoral anteversion. In this exhibit the authors compare the modified technique with the old technique. Details of femoral had deficits, acetabular configuration, the arc of the acetabulum, the relative position of the femoral head within the acetabulum, and the soft tissue interposed between the femoral head and the acetabulum are well demonstrated with the new technique

  2. CT evaluation of acetabular dysplasta in adults.

    2000-01-01

    Objective: To evaluate methods of measurement by CT and their clinical significance for acetabular dysplasia(AD) in adults. Methods: CT imaging was examined and measured in 33 adult patients with AD, compared with the normal control group of 210 adults. Results: This study showed the results of AD patients

  3. Deformation process and interaction of acetabular cup

    Jíra, J.; Jírová, Jitka; Micka, Michal

    Dusseldorf, Německo: VDI Verlag GmbH, 2001, s. 197-202. ISBN 3-18-091599-4. [GESA-Symposium 2001. Chemnitz (DE), 17.05.2001-18.05.2001] R&D Projects: GA ČR GA103/00/0831 Keywords : acetabular cup migration, computation modelling,straingauge measurement. Subject RIV: FI - Traumatology, Orthopedics

  4. Effects of normal and abnormal loading conditions on morphogenesis of the prenatal hip joint: application to hip dysplasia.

    Giorgi, Mario; Carriero, Alessandra; Shefelbine, Sandra J; Nowlan, Niamh C

    2015-09-18

    Joint morphogenesis is an important phase of prenatal joint development during which the opposing cartilaginous rudiments acquire their reciprocal and interlocking shapes. At an early stage of development, the prenatal hip joint is formed of a deep acetabular cavity that almost totally encloses the head. By the time of birth, the acetabulum has become shallower and the femoral head has lost substantial sphericity, reducing joint coverage and stability. In this study, we use a dynamic mechanobiological simulation to explore the effects of normal (symmetric), reduced and abnormal (asymmetric) prenatal movements on hip joint shape, to understand their importance for postnatal skeletal malformations such as developmental dysplasia of the hip (DDH). We successfully predict the physiological trends of decreasing sphericity and acetabular coverage of the femoral head during fetal development. We show that a full range of symmetric movements helps to maintain some of the acetabular depth and femoral head sphericity, while reduced or absent movements can lead to decreased sphericity and acetabular coverage of the femoral head. When an abnormal movement pattern was applied, a deformed joint shape was predicted, with an opened asymmetric acetabulum and the onset of a malformed femoral head. This study provides evidence for the importance of fetal movements in the prevention and manifestation of congenital musculoskeletal disorders such as DDH. PMID:26163754

  5. Imaging of sports-related hip and groin injuries.

    Lischuk, Andrew W; Dorantes, Thomas M; Wong, William; Haims, Andrew H

    2010-05-01

    A normally functioning hip joint is imperative for athletes who use their lower extremities with running, jumping, or kicking activities. Sports-related injuries of the hip and groin are far less frequent than injuries to the more distal aspect of the extremity, accounting for less than 10% of lower extremity injuries. Despite the lower incidence, hip and groin injuries can lead to significant clinical and diagnostic challenges related to the complex anatomy and biomechanical considerations of this region. Loads up to 8 times normal body weight have been documented in the joint in common daily activities, such as jogging, with significantly greater force expected during competitive athletics. Additionally, treatment for hip and groin injuries can obviate the participation of medical and surgical specialties, with a multidisciplinary approach frequently required. Delay in diagnosis and triage of these injuries may cause loss of time from competition and, potentially, early onset of degenerative changes. Magnetic resonance imaging (MRI) of the hip has proven to be the gold standard for the diagnosis of sports-related hip and groin injuries in the setting of negative radiographs. With its exquisite soft tissue contrast, multiplanar capabilities, and lack of ionizing radiation, MRI is unmatched in the noninvasive diagnosis of intra-articular and extra-articular pathology, as well as intraosseous processes. This review focuses on MRI of common athletic injuries of the hip and groin, including acetabular labral tears, femoral acetabular impingement syndrome, muscle injuries around the hip and groin (including athletic pubalgia), and athletic osseous injuries. PMID:23015946

  6. The Main Biomechanical Risk Factors for the Prevalence of the Left Hip Joint Traumatic and Degenerative Changes

    Lovrić, Ivan; Splavski, Bruno; Jovanović, Savo; Soldo, Ivan; Kvolik, Slavica; Has, Borislav

    2009-01-01

    The aim of this paper is to examine characteristic biomechanical features leading to the acetabular fracture and hip joint arthrosis, and to explain the prevalence of the left side traumatic and degenerative pelvic pathology that is usually seen in diverse groups of patients. A total of 253 patients were analyzed in a retrospective case-control study during a six-year period. The patients were divided into the case group of 103 patients suffering traumatic acetabular fractures and into the co...

  7. Hip Replacement

    Hip replacement is surgery for people with severe hip damage. The most common cause of damage is ... therapy, pain medicines, and exercise haven't helped, hip replacement surgery might be an option for you. ...

  8. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty

    Zilkens C

    2011-03-01

    Full Text Available Abstract The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA. One hundred 'and one (94.4% acetabular components did not show significant migration of more than 1 mm. Six (5.6% implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous- coated acetabular components for primary THA does not prevent cup migration.

  9. Migration pattern of cementless press fit cups in the presence of stabilizing screws in total hip arthroplasty.

    Zilkens, C; Djalali, S; Bittersohl, B; Kälicke, T; Kraft, C N; Krauspe, R; Jäger, Marcus

    2011-03-28

    The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration. PMID:21486725

  10. Unilateral hip osteoarthritis: can we predict the outcome of the other hip?

    Vossinakis, I.C. [General Hospital of Volos, Orthopaedic Department, Volos (Greece); Georgiades, G. [General Hospital of Tripoli, Tripoli Greece, Orthopaedic Department, Athens (Greece); Hartofilakidis, G. [University of Athens Medical School, Department of Orthopaedics, Athens (Greece); Kafidas, D.

    2008-10-15

    The objective of this study was to define, in unilateral hip osteoarthritis (OA), factors predicting the outcome of the other hip. We examined the anteroposterior radiographs of the pelvis of 95 white patients with unilateral idiopathic (56 patients) or secondary to congenital hip diseases (39 patients) OA. The other hip was free from symptoms (pain or limping) at the initial examination and without radiographic evidence of OA; it was what we call a ''normal'' hip. Two parameters were evaluated: (1) the type of osteoarthritis of the involved hip and (2) the range of four radiographic indices of the contralateral hip: the sourcil inclination (weight-bearing surface), the acetabular angle, the Wiberg's center-edge angle, and the neck-shaft angle. Follow-up radiographs for the hips that remained OA-free were available for 10 to 35 years and for those that developed OA, at the time of initial symptoms, range 2 to 31 years. Logistic regression analysis showed that the presence of idiopathic OA in one hip had a statistically significant effect on the development of OA on the other hip (p<0.001). Minor deviations of radiographic indices of the contralateral hip is not a predictive factor for its outcome. When the radiographic indices are examined together with the pathology of the involved hip, only WBS was shown to have a significant effect to the development of OA and its type (p < 0.001). The following conclusions can be drawn from this study: 1. Patient with idiopathic OA of one hip is at increased risk of developing OA in the other hip. 2. The outcome of the other hip cannot be predicted only on the basis of the evaluation of its radiographic indices. 3. Among the different indices, WBS seems to have a strong influence toward the development of OA. (orig.)

  11. Surface evaluation of orthopedic hip implants marketed in Brazil

    Souza, M. M.; Trommer, R. M.; Maru, M. M.; Roesler, C. R. M.; Barros, W. S.; Dutra, M. S.

    2016-07-01

    One of the factors that contribute to the quality of total hip prostheses is the degree of accuracy in the manufacturing of the joint surfaces. The dimensional control of joint components is important because of its direct influence on the durability and, consequently, in the patients’ life quality. This work presents studies on the form and roughness of orthopedic hip prostheses marketed in Brazil. The results provide data for quality control of the surfaces of the femoral heads and acetabular components of hip prostheses and indicate the need of improvement in the procedures used to this control.

  12. Acetabular reconstruction with human and bovine freeze-dried bone grafts and a reinforcement device

    Ricardo Rosito

    2008-01-01

    Full Text Available BACKGROUND: This is a cohort trial (1997-2005 of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG and a reinforcement device. OBJECTIVE: To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS: There were two groups: I (n=26 receiving human grafts and II (n=25 receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d'Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn's et al. criteria for radiographic bone incorporation. RESULTS: No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424. CONCLUSION: The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty.

  13. Acetabular Reconstruction with Human and Bovine Freeze- Dried Bone Grafts and a Reinforcement Device

    Rosito, Ricardo; Galia, Carlos Roberto; Macedo, Carlos Alberto Souza; Moreira, Luis Fernando; Quaresma, Lourdes Maria Araújo C.; Palma, Humberto Moreira

    2008-01-01

    BACKGROUND This is a cohort trial (1997–2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d’Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn’s et al. criteria for radiographic bone incorporation. RESULTS No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty. PMID:18719763

  14. Periacetabular osteotomy for acetabular dysplasia%髋臼周围截骨术治疗髋臼发育不良

    李华; 王云清; 魏东

    2011-01-01

    目的 探讨髋臼周围截骨术治疗髋臼发育不良的方法 及疗效.方法 对36例髋臼发育不良患者(43髋)行手术治疗,通过髋臼周围截骨、旋转髋臼向前外侧移位恢复髋臼的正确位置,并增加髋臼覆盖面.结果 36例均获随访,时间 6个月~3年.术后髋痛、跛行完全消失或有明显改善,髋关节活动范围基本正常.CE角和Sharp角均基本恢复正常.结论 髋臼周围截骨术可有效改善临床症状,恢复髋关节的生物力学特点,是治疗髋臼发育不良的有效方法.%Objective To discuss the method and effect of the treatment of acetabular dysplasia by periacetabular acetabular osteotomy. Methods Periacetabular osteotomy was performed to correct 36 patients( 43 hips )with dysplastic acetabulum through rotating the acetabulum anterolaterally, by which the position and acetabular coverage of the femoral head was restored to nearly normal. Results 36 patients with acetabular dysplasia were all followed up for six months to three years. After operation, in the majority, the hip limp or pain with exertion disappeared, and a satisfactory range of motion had been restored. CE angle and Sharp angle were restored to nearly normal value. Conclusions Periacetabular osteotomy is effectively to improve the clinical symptoms, and restore the hip biomechanics characteristics,which is ideal for the treatment of developmental acetabular dysplasia.

  15. Vibroacoustography for the assessment of total hip arthroplasty

    Hermes A.S. Kamimura

    2013-04-01

    Full Text Available OBJECTIVES: This paper proposes imaging with 3-dimensional vibroacoustography for postoperatively assessing the uncovered cup area after total hip arthroplasty as a quantitative criterion to evaluate implant fixation. METHODS: A phantom with a bone-like structure covered by a tissue-mimicking material was used to simulate a total hip arthroplasty case. Vibroacoustography images of the uncovered cup region were generated using a two-element confocal ultrasound transducer and a hydrophone inside a water tank. Topological correction based on the geometry of the implant was performed to generate a 3-dimensional representation of the vibroacoustography image and to accurately evaluate the surface. The 3-dimensional area obtained by the vibroacoustography approach was compared to the area evaluated by a 3-dimensional motion capture system. RESULTS: The vibroacoustography technique provided high-resolution, high-contrast, and speckle-free images with less sensitivity to the beam incidence. Using a 3-dimensional-topology correction of the image, we accurately estimated the uncovered area of the implant with a relative error of 8.1% in comparison with the motion capture system measurements. CONCLUSION: Measurement of the cup coverage after total hip arthroplasty has not been well established; however, the covered surface area of the acetabular component is one of the most important prognostic factors. The preliminary results of this study show that vibroacoustography is a 3-dimensional approach that can be used to postoperatively evaluate total hip arthroplasty. The favorable results also provide an impetus for exploring vibroacoustography in other bone or implant surface imaging applications.

  16. Revision Total Hip Replacement: A Case Report

    Md Hafizur Rahman

    2013-07-01

    Full Text Available Total hip replacement is a reconstructive procedure that has improved the management of those diseases of the hip joint that have responded poorly to conventional medical therapy. Conventional, primary total hip replacement is a durable operation in the majority of patients. A hip replacement is a mechanical device with parts that are assembled before and during the operation. But the possible complications of total hip arthroplasty, and its clinical performance over time, is a challenging occasion to the surgeons, and such a challenge we faced with our presenting patient. A 68 year old lady with history of cemented bipolar hemiarthroplasty done in a tertiary care hospital, due to fracture neck of the left femur having the history of diabetes, chronic kidney disease, heart disease, anaemia, and mental disorders presented with loosened prosthesis, thinning of medial proximal cortex of the femur which had broken within few months after surgery. She complained of painful walking at left hip joint. There was also evidence of chronic infective and degenerative arthritis of acetabular component of the affected hip joint. Cemented revision total hip replacement surgery was performed with expert multidisciplinary involvement. On 2nd postoperative day the patient was allowed to walk on operated limb with the aid of walker. On 12th postoperative day all the stitches were removed and wound was found healthy.

  17. Computed tomography analysis of acetabular anteversion and abduction

    Stem, Eric S. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); South Carolina Sports Medicine and Orthopaedic Center, North Charleston, SC (United States); O' Connor, Mary I. [Mayo Clinic, Department of Orthopedic Surgery, Jacksonville, FL (United States); Kransdorf, Mark J. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Crook, Julia [Mayo Clinic, Biostatistic Unit, Jacksonville, FL (United States)

    2006-06-15

    The purpose of this study is to define the normal range of acetabular abduction and anteversion in relation to pelvic anatomy as depicted on conventional CT scan. We retrospectively reviewed 100 pelvic CT scans performed on patients presenting for evaluation of non-orthopaedic pathology. The study group consisted of 58 women and 42 men, aged between 18 and 88 years. Standard imaging protocol included an anteroposterior (AP) topogram with contiguous 5-mm thick axial images from the superior margin of the iliac crest to the lesser trochanter of the femur. The acetabular abduction was measured from the AP topogram by obtaining the angle between a line drawn from the acetabular teardrop to the lateral acetabular margin and a horizontal line between the ischial tuberosities. Acetabular anteversion was measured on axial images at the level of the mid-femoral head. We found the mean acetabular abduction to be 39 degrees (standard deviation 4 degrees, range 27 to 51 degrees) and the mean acetabular anteversion to be 23 degrees (standard deviation 5 degrees, range 12 to 39 degrees). Data suggests that acetabular anteversion may average 2.7 degrees lower in males than females and increase slightly with age, while abduction may tend to decrease with age. Ninety percent of patients had acetabular abduction between 31 and 46 degrees; the 90% central range for acetabular anteversion was estimated to be from 14 to 31 degrees. CT scanning is useful in accurately defining the normal range of acetabular abduction and antiversion. Knowledge of this normal anatomy will allow accurate assessment of acetabular component position as delineated on conventional CT scanning. (orig.)

  18. Quantification of clearance and creep in acetabular wear measurements

    Gregory, Thomas; Vandenbussche, Eric

    2016-01-01

    Background This study aimed to measure femoral head penetration before occurrence of real wear, and to quantify the portions attributable respectively to clearance and plastic deformations in various acetabular designs. Methods We analyzed CT scans from 15 patients at ‘day five’ after total hip arthroplasty (THA). All patients received Exafit® femoral stems and 28 mm heads: 5 patients had cemented Durasul® all-PE cups, 5 patients had un-cemented Allofit® metal-backed cups, and 5 patients had un-cemented Stafit® dual-mobility cups. We also analyzed CT scans of samples of the three head-cup combinations to compare in vivo and in vitro measurements. Results The mean femoral head penetration measured on ‘day five’ was lower for all-PE cups (0.196 mm) than for metal-backed cups (0.551 mm) and dual-mobility cups (0.634 mm). Conclusions The present study indicates that isolated measurements of femoral head penetration include 0.15–0.46 mm of radial clearance and 0.05–0.27 mm of creep, and confirms that the majority of so-called bedding-in observed in the first post-operative months is not entirely due to wear. PMID:27162781

  19. Magnetic resonance arthrography of the acetabular labral lesion

    Magnetic resonance arthrography (MRA) is a reliable diagnostic method with high sensitivity and accuracy for acetabular labral lesion in the hip joint. This paper describes the present state and task of the method mainly based on authors' experience. Subjects are 18 patients with the lesion, whose 10 joints have dysplastic shelf (Sharp angle >45 degrees). Enhanced T1-weighted, and 3D T2 as well, MRA is conducted with the machine Signa Excite 3.0 T (GE), rapidly after injection in the joint cavity of 10-20 mL of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) 100 times-diluted by iopamidol. Abnormal MRA findings involve the labral morphology of circular edge, flatness, irregular contour and shrink/disappearance, and the image of high brightness in parenchyma, invasion of the contrast medium there, and discontinuousness between the shelf edge and labrum. The lesion predominantly exists at anterior and superior portion on the labrum and the images of ganglion and synovial cyst suggest the existence of labral tear. Normal variants can give a part of the abnormal MRA findings above, and thus who require the differential diagnosis for the lesion. Education of MRA is a task for general orthopedists. (R.T.)

  20. Acetabular anteversion is associated with gluteal tendinopathy at MRI

    Moulton, Kyle M. [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada); Royal University Hospital, Department of Medical Imaging, Saskatoon, SK (Canada); Aly, Abdel-Rahman [University of Saskatchewan, Department of Physical Medicine and Rehabilitation, Saskatoon, SK (Canada); Rajasekaran, Sathish [Health Pointe - Pain, Spine and Sport Medicine, Edmonton, AB (Canada); Shepel, Michael; Obaid, Haron [University of Saskatchewan, Department of Medical Imaging, Saskatoon, SK (Canada)

    2015-01-15

    Gluteal tendinopathy and greater trochanteric pain syndrome (GTPS) remain incompletely understood despite their pervasiveness in clinical practice. To date, no study has analyzed the morphometric characteristics of the hip on magnetic resonance imaging (MRI) that may predispose to gluteal tendinopathy. This study aimed to evaluate whether acetabular anteversion (AA), femoral neck anteversion (FNA), and femoral neck-shaft angle (FNSA) are associated with MRI features of gluteal tendinopathy. A total of 203 MRI examinations of the hip met our inclusion and exclusion criteria. A single blinded investigator measured AA, FNA, and FNSA according to validated MRI techniques. Two blinded subspecialty-trained musculoskeletal radiologists then independently evaluated the presence of gluteal tendinosis, trochanteric bursitis, and subgluteal bursitis. Statistical analysis was performed using a one-way analysis of variance (ANOVA; post-hoc Tukey's range test). At MRI, 57 patients had gluteal tendinosis with or without bursitis, 26 had isolated trochanteric bursitis, and 11 had isolated subgluteal bursitis. AA was significantly (p = 0.01) increased in patients with MRI evidence of gluteal tendinosis with or without bursitis [mean: 18.4 , 95 % confidence interval (CI): 17.2 -19.6 ] compared with normal controls (mean: 15.7 , 95 % CI: 14.7 -16.8 ). Similarly, AA was significantly (p = 0.04) increased in patients with isolated trochanteric bursitis (mean: 18.8 , 95 % CI: 16.2 -21.6 ). No association was found between FNA or FNSA and the presence of gluteal tendinopathy. Interobserver agreement for the presence and categorization of gluteal tendinopathy was very good (kappa = 0.859, 95 % CI: 0.815-0.903). Our MRI study suggests that there is an association between increased AA and gluteal tendinopathy, which supports a growing body of evidence implicating abnormal biomechanics in the development of this condition. (orig.)

  1. Analysis of the acetabulum by CT scan in Japanese with osteoarthritis of the hip

    The morphology of the acetabulum was analyzed by CT scan in 66 Japanese patients with osteoarthritis of the hip mainly following congenital dislocation or dysplasia. The CT scan data was analyzed to standardize the pelvic inclination in all directions. In these patients, the acetabular floor had thickened and the acetabulum was located in the anterolateral portion. The bilateral difference in the acetabular anteversion angle was not different between patients and normal individuals, but the acetabular sector angle in patients was smaller than in the normal subjects. As the stage of osteoarthritis of the hip advanced, the thickness of the acetabular floor in the center and posterior portions and the anterior sector angle increased, and the lateralization of the acetabulum advanced, but the anteversion angle decreased. A bone-forming change is characteristic of the anterior acetabulum and acetabular fossa in the center and posterior portions in Japanese patients with osteoarthritis of the hip. In comparison with data obtained by standard radiography, these changes detected by CT scan corresponded to an increase of the width of a tear drop, the lateralization of the femoral head and the lack of the support of the femoral head from the acetabulum. (author)

  2. Analysis of the acetabulum by CT scan in Japanese with osteoarthritis of the hip

    Ishibashi, Masanori [Keio Univ., Tokyo (Japan). School of Medicine

    1997-11-01

    The morphology of the acetabulum was analyzed by CT scan in 66 Japanese patients with osteoarthritis of the hip mainly following congenital dislocation or dysplasia. The CT scan data was analyzed to standardize the pelvic inclination in all directions. In these patients, the acetabular floor had thickened and the acetabulum was located in the anterolateral portion. The bilateral difference in the acetabular anteversion angle was not different between patients and normal individuals, but the acetabular sector angle in patients was smaller than in the normal subjects. As the stage of osteoarthritis of the hip advanced, the thickness of the acetabular floor in the center and posterior portions and the anterior sector angle increased, and the lateralization of the acetabulum advanced, but the anteversion angle decreased. A bone-forming change is characteristic of the anterior acetabulum and acetabular fossa in the center and posterior portions in Japanese patients with osteoarthritis of the hip. In comparison with data obtained by standard radiography, these changes detected by CT scan corresponded to an increase of the width of a tear drop, the lateralization of the femoral head and the lack of the support of the femoral head from the acetabulum. (author)

  3. Efficient radiologic diagnosis of pelvic and acetabular trauma

    In spite of the widespread availability of CT scanners, conventional X-ray radiographs remain the basic imaging modality in patients with pelvic and/or acetabular trauma. However, the extent of their use will depend on local utilities (e.g., availability of CT scanners) and on the patient's clinical condition. Regarding the inaccuracy of conventional radiography in the diagnosis of injuries of the dorsal pelvic ring and of the acetabulum, computed tomography represents the most important imaging modality in the clinically stable patient. CT provides an exact staging of the extent of trauma and allows for differentiation of pelvic instabilities. CT clearly demonstrates the severity of acetabular trauma and is superior in the detection of local complicating factors, i.e., impressions fractures and (sub-)luxations of the femoral head as well as free intraarticular fragments. CT findings provide the basis for definite treatment regimens of the injured patient. By extension of the examination, all relevant organs and systems (craniospinal, cardiovascular, gastrointestinal, respiratory, genitourinary) can be imaged during one session. The speed of spiral CT scanners and their diagnostic accuracy will play a major role in the management of, especially, polytraumatized patients. The indication for angiography with the option of therapeutic embolization exists if a pelvic bleeding persists even after reposition and operative fixation of the injury. (orig.)

  4. The Use of Iliac Stem Prosthesis for Acetabular Defects following Resections for Periacetabular Tumors

    De Paolis, Massimiliano; Romagnoli, Carlo; Alì, Nikolin; Giannini, Sandro; Donati, Davide Maria

    2013-01-01

    Introduction. The management of pelvic tumors is a challenge for orthopaedic oncologists due to the complex anatomy of the pelvis and the need to have extensive exposure. Various reconstructive techniques have been proposed with poor functional results and a high percentage of complications. Our purpose is to determine the functional results and the rate of complications of iliac stem prosthesis for acetabular defects following resections for periacetabular tumors. Materials and Methods. Between 1999 and 2012, 45 patients underwent pelvic resections for periacetabular bone tumors followed by reconstruction with stem cup prosthesis. The most common diagnosis was CS (chondrosarcoma, 29 cases), followed by OS (osteosarcoma, 9 cases) and metastasis (3 cases). In 33 cases, this implant was associated with massive bone allografts. Minimum follow-up required to evaluate functional outcome was 2 years. We classified pelvic resections according to Enneking and Dunham's classification and we used MSTS (musculoskeletal tumor system) score to evaluate functional outcomes. Results and Discussion. Sixteen patients died of their disease, three were lost to follow-up, four are alive with disease, and twenty-two are alive with no evidence of disease. Fifteen patients had local recurrence. Sixteen patients had bone or lung metastasis. We have had 6 infections, 2 aseptic loosening, and 2 cases of hip dislocation. Iliac sovracetabular osteotomy was fused in all cases at 10 months from surgery. Functional results were good or excellent in 25 of 31 patients with long-term follow-up (77%), with a percentage similar to that reported in the literature. Conclusion. The use of iliac stem prosthesis is a simple reconstructive technique that reduces operative times and risk of infection. It allows having good results and low rate of complications, but it should be performed in selected cases and centres of reference. PMID:24250275

  5. Hip Revision with Cup Removal System and Revision Shell

    Full Text Available The Zimmer® Explant® Cup Removal System and Trabecular Metal™ Revision Shell You must have Javascript enabled in your web browser. View Program Transcript Click Here to view ...

  6. Study of the three-dimensional orientation of the labrum: its relations with the osseous acetabular rim

    Bonneau, Noémie; Bouhallier, July; Baylac, Michel; Tardieu, Christine; Gagey, Olivier

    2012-01-01

    Understanding the three-dimensional orientation of the coxo-femoral joint remains a challenge as an accurate three-dimensional orientation ensure an efficient bipedal gait and posture. The quantification of the orientation of the acetabulum can be performed using the three-dimensional axis perpendicular to the plane that passes along the edge of the acetabular rim. However, the acetabular rim is not regular as an important indentation in the anterior rim was observed. An innovative cadaver study of the labrum was developed to shed light on the proper quantification of the three-dimensional orientation of the acetabulum. Dissections on 17 non-embalmed corpses were performed. Our results suggest that the acetabular rim is better represented by an anterior plane and a posterior plane rather than a single plane along the entire rim as it is currently assumed. The development of the socket from the Y-shaped cartilage was suggested to explain the different orientations in these anterior and posterior planes. The labrum forms a plane that takes an orientation in between the anterior and posterior parts of the acetabular rim, filling up inequalities of the bony rim. The vectors VL, VA2 and VP, representing the three-dimensional orientation of the labrum, the anterior rim and the posterior rim, are situated in a unique plane that appears biomechanically dependent. The three-dimensional orientation of the acetabulum is a fundamental parameter to understand the hip joint mechanism. Important applications for hip surgery and rehabilitation, as well as for physical anthropology, were discussed. PMID:22360458

  7. Colour doppler ultrasound assessment of the normal neonatal hip

    To determine the morphology and hemodynamic characteristics of the arterial vessels of the proximal femur according to specific anatomic regions in asymptomatic neonates in 2 pediatric-based health care institutions. Forty-three neonates (29 female, 14 male; age range, 2 d-3 mo; median age, 3 d) were enrolled in the study. Thirty-two (37%) of 86 hips were classified as Graf type IIA joints (mean alpha angle, 56.0o ± 2.7o), and 54 (63%) were classified as type I joints (mean alpha angle, 65.0o ± 4.6o). Colour and spectral Doppler imaging identified vessels running along the acetabular labrum, epiphyseal vessels, and femoral neck. We showed 4 different patterns of vascularity of the hips: radial, parallel, mixed radial-parallel, and indeterminate, however, they were not related to the hip maturity (P = .3, coronal plane; P = .62, transverse plane) or to the amount of colour pixels identified in each region (P = .35). The mean number of pixels in the ligamentum teres region was significantly higher than that in other regions of interest (P =.03). Except for the acetabular labrum arteries, Doppler spectrum waveforms of proximal femur arteries presented with low resistivity. There was a tendency towards females' acetabular arteries presenting with lower peak systolic velocities than males' acetabular arteries (P =.06). Colour Doppler spectrum waveforms and intensity of vascularity in normal neonatal hips differ according to the anatomic region under evaluation. This observation deserves further investigation on its role on the physiopathogenesis of neonatal hip disorders. (author)

  8. Colour doppler ultrasound assessment of the normal neonatal hip

    Ortiz-Neira, C.L. [Dept. of Diagnostic Imaging, Alberta Children' s Hospital, Calgary, Alberta (Canada)], E-mail: clara.ortiz@calgaryhealthregion.ca; Laffan, E.; Daneman, A. [Dept. of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario (Canada); Fong, K. [Dept. of Diagnostic Imaging, Mount Sinai Hospital, Toronto, Ontario (Canada); Roposch, A. [Dept. of Orthopedic Surgery, The Hospital for Sick Children, Toronto, Ontario (Canada); Great Ormond Street Hospital, Inst. of Child Health, Univ. College London, London (United Kingdom)

    2009-04-15

    To determine the morphology and hemodynamic characteristics of the arterial vessels of the proximal femur according to specific anatomic regions in asymptomatic neonates in 2 pediatric-based health care institutions. Forty-three neonates (29 female, 14 male; age range, 2 d-3 mo; median age, 3 d) were enrolled in the study. Thirty-two (37%) of 86 hips were classified as Graf type IIA joints (mean alpha angle, 56.0{sup o} {+-} 2.7{sup o}), and 54 (63%) were classified as type I joints (mean alpha angle, 65.0{sup o} {+-} 4.6{sup o}). Colour and spectral Doppler imaging identified vessels running along the acetabular labrum, epiphyseal vessels, and femoral neck. We showed 4 different patterns of vascularity of the hips: radial, parallel, mixed radial-parallel, and indeterminate, however, they were not related to the hip maturity (P = .3, coronal plane; P = .62, transverse plane) or to the amount of colour pixels identified in each region (P = .35). The mean number of pixels in the ligamentum teres region was significantly higher than that in other regions of interest (P =.03). Except for the acetabular labrum arteries, Doppler spectrum waveforms of proximal femur arteries presented with low resistivity. There was a tendency towards females' acetabular arteries presenting with lower peak systolic velocities than males' acetabular arteries (P =.06). Colour Doppler spectrum waveforms and intensity of vascularity in normal neonatal hips differ according to the anatomic region under evaluation. This observation deserves further investigation on its role on the physiopathogenesis of neonatal hip disorders. (author)

  9. Hip Revision

    Full Text Available ... the acetabular revision side; and hopefully by the time we've been there -- or get there -- he ... précis on what he's done up to that time. Here's Scott's initial preoperative x-ray, where we ...

  10. Space systems engineering and risk management - joined at the hip

    Rose, James R.

    2004-01-01

    This paper explores the separate skills and capabilities practiced until now, and the powerful coupling to be achieved, practically and effectively, in implementing a space mission, from inception (pre-phase A) to the end of Operations (phase E). The use of risk assessment techniques in balancing cost risk against performance risk, and the application of the systems engineering team in these trades, is the key to achieving this new implementation paradigm.

  11. Infant Hip Joint Diagnostic Support System Based on Clinical Manifestations in X-ray Images

    Honda, Mitsugi; Arita, Seizaburo; Mitani, Shigeru; TAKEDA, Yoshihiro; Ozaki,Toshifumi; Inamura, Keiji; Kanazawa, Susumu

    2010-01-01

    Plain X-ray radiography is frequently used for the diagnosis of developmental dislocation of the hip (DDH). The aim of this study was to construct a diagnostic support system for DDH based on clinical findings obtained from the X-ray images of 154 female infants with confirmed diagnoses made by orthopedists. The data for these subjects were divided into 2 groups. The Min-Max method of nonlinear analysis was applied to the data from Group 1 to construct the diagnostic support system based on t...

  12. Influence of anaesthesia on canine hip dysplasia score.

    Genevois, J-P; Chanoit, G; Carozzo, C; Remy, D; Fau, D; Viguier, E

    2006-10-01

    Hip dysplasia (HD) scores, based on the five grades, as defined by the Fédération Cynologique Internationale, were compared between anaesthetized (group 1, n = 3839) and non-sedated non-anaesthetized dogs (group 2, n = 1517). Each dog was radiographed in the standard ventro-dorsal hip joint extended position. Each radiograph was evaluated by the same reader blinded regarding the dog's status of anaesthesia. Results showed that there was a significant difference in hip dysplasia prevalence between group 1 (22%) compared with group 2 (9%) (P < 0.005). This difference was the result of a lower rate of hip-joint laxity assessment and the measurement of Norberg-Olsson angle <105 degrees in group 2 compared with group 1. The acetabular and femoral morphologies were not significantly different between the groups. The data confirm that the scoring of dogs for HD on standard radiographs with the hip joints extended is influenced by anaesthesia. PMID:16970631

  13. IPSILATERAL TRAUMATIC POSTERIOR DISLOCATION OF THE HIP ACCOMPANIED BY PRETROCHANTERC FRACTURE

    Taser, Omer; Cakmak, Mehmet; Cubuk, Mustafa Kemal; Domanic, Unsal; Karamehmetoglu, M.

    2004-01-01

    Attempts have been made to present a case with ipsilateral traumatic posterior dislocation of the hip and fracture of the trachanteric region without any acetabular fracture. In this unique case with no second in the literature, treatment of choice has been discussed and late results obtained from this case reported.

  14. Hip Subluxation, first clinical manifestation in a boy with illness of Charcot Marie Tooth

    Charcot-Marie-Tooth disease is a motor and sensitive neuropathy characterized by limb atrophy and weakness, cavus feet and in some cases acetabular dysplasia. We present a case of bilateral hip subluxation caused by this disease, which needed surgical correction

  15. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty

    Pawel Zwolak; Peer Eysel; Joern William-Patrick Michael

    2011-01-01

    Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan ...

  16. Reliability of Hip Migration Index in Children with Cerebral Palsy: The Classic and Modified Methods

    Kim, Sun Mi; Sim, Eun Geol; Lim, Seong Gyu; Park, Eun Sook

    2012-01-01

    Objective To determine reliability and clinical use of two methods of migration index (MI) in CP patients with or without hip dysplasia. Method The materials included radiographs of 200 hips of children with cerebral palsy. Conventional anteroposterior radiographs of the pelvis were taken with the child in the supine position with standardized methods. Two rehabilitation doctors measured the migration index using two methods. In the classic method, the lateral margin of the acetabular roof wa...

  17. The acetabular fossa hot spot on {sup 18}F-FDG PET/CT: epidemiology, natural history, and proposed etiology

    Kubicki, Shelby L. [Trinity University, San Antonio, TX (United States); Richardson, Michael L. [University of Washington, Department of Radiology, Seattle, WA (United States); Martin, Thomas [X-Ray Associates of New Mexico, Department of Radiology, Albuquerque, NM (United States); Rohren, Eric [The University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology, Division of Nuclear Medicine, Houston, TX (United States); Wei, Wei [The University of Texas M.D. Anderson Cancer Center, Department of Biostatistics, Houston, TX (United States); Amini, Behrang [The University of Texas M.D. Anderson Cancer Center, Department of Diagnostic Radiology, Division of Musculoskeletal Radiology, Houston, TX (United States)

    2015-01-15

    To describe a benign focus of increased activity in the acetabular fossa (the acetabular fossa hot spot, AFHS) on {sup 18}F-FDG PET/CT that can mimic a neoplasm. {sup 18}F-FDG PET/CT images from four patient populations were examined. Group 1 (n = 13) was collected from a search of radiology reports and used to define the AFHS and for hypothesis generation. Group 2 (n = 1,150) was used for prevalence of AFHS. Group 3 (n = 1,213) had PET/CT and MRI pelvis within a week of each other and was used to correlate metabolic and anatomic findings. Group 4 (n = 100) was used to generate the control group. Data were collected on demographics, common comorbidities, underlying cancer diagnosis and status, and hip symptoms. Prevalence of AFHS was 0.36 % (95 % CI 0.10-0.91 %). None progressed to malignancy or was associated with cancer status. The majority (71 %) were on the left, and 6 % were bilateral. Mean SUV{sub max} of the AFHS was 4.8 (range, 2.7-7.8). Male patients were more likely to have the AFHS (OR = 8.69, 95 % CI 1.88-40.13). There was no difference with respect to other collected data, including hip symptoms. Average minimum duration of AFHS was 346 days (range, 50-1,010 days). Readers did not detect corresponding hip abnormalities on MRIs. AFHS is a benign finding that may be caused by subclinical ligamentum teres injury, focal synovitis, or degeneration of acetabular fossa fat. Despite uncertainty regarding its etiology, recognition of AFHS as a benign finding can prevent morbidity associated with unnecessary biopsy or initiation of therapy. (orig.)

  18. The acetabular fossa hot spot on 18F-FDG PET/CT: epidemiology, natural history, and proposed etiology

    To describe a benign focus of increased activity in the acetabular fossa (the acetabular fossa hot spot, AFHS) on 18F-FDG PET/CT that can mimic a neoplasm. 18F-FDG PET/CT images from four patient populations were examined. Group 1 (n = 13) was collected from a search of radiology reports and used to define the AFHS and for hypothesis generation. Group 2 (n = 1,150) was used for prevalence of AFHS. Group 3 (n = 1,213) had PET/CT and MRI pelvis within a week of each other and was used to correlate metabolic and anatomic findings. Group 4 (n = 100) was used to generate the control group. Data were collected on demographics, common comorbidities, underlying cancer diagnosis and status, and hip symptoms. Prevalence of AFHS was 0.36 % (95 % CI 0.10-0.91 %). None progressed to malignancy or was associated with cancer status. The majority (71 %) were on the left, and 6 % were bilateral. Mean SUVmax of the AFHS was 4.8 (range, 2.7-7.8). Male patients were more likely to have the AFHS (OR = 8.69, 95 % CI 1.88-40.13). There was no difference with respect to other collected data, including hip symptoms. Average minimum duration of AFHS was 346 days (range, 50-1,010 days). Readers did not detect corresponding hip abnormalities on MRIs. AFHS is a benign finding that may be caused by subclinical ligamentum teres injury, focal synovitis, or degeneration of acetabular fossa fat. Despite uncertainty regarding its etiology, recognition of AFHS as a benign finding can prevent morbidity associated with unnecessary biopsy or initiation of therapy. (orig.)

  19. Triple osteotomy of the pelvis and trochanteric osteotomy as a treatment for hip dysplasia in the immature dog: the surgical technique and results of 77 consecutive operations

    Triple osteotomy of the pelvis with transplantation of the greater trochanter was performed in 41 immature dogs (77 hips) with hip dysplasia. Before surgery, all hips were moderately to severely subluxated and unstable on palpation. The juxta-acetabular location of the ilial, ischial, and pubic osteotomies allowed repositioning of the acetabulum over the femoral head even when subluxation was severe. The acetabular fragment was rotated 70 degrees to 90 degrees in all hips. After surgery, craniodorsal coverage of the femoral head was increased and each hip was stable on palpation. Bilateral procedures were performed 4 to 7 weeks apart. The functional status of the limb was assessed and physical examination and radiography were performed in 71% (55) of the hips 1.0 to 5.5 years (mean, 2.7 years) after surgery. Functional ability was considered satisfactory in 93% (51) of the limbs, though few dogs had a normal gait. On palpation, all hips were stable and all but one were evaluated as nonpainful. In most instances, contact between the femoral neck and the repositioned acetabular rim resulted in a variable amount of crepitus and restriction of motion when the hip was abducted and rotated externally and internally. Eighty-two percent (45) of the hips had little or no evidence of degenerative joint disease. A satisfactory functional, physical, and radiographic result was obtained in 73% (40) of the hips

  20. Taper Hip Prosthesis

    Full Text Available Zimmer M/L Taper Hip Prosthesis with Modular Neck Kinectiv® Technology March 12, 2009 7:00 PM EDT Welcome to this "OR Live" Webcast presentation ... an "OR Live" Webcast on the Kinectiv Total Hip System. At this time, let’s join Dr. Maltry ...

  1. M2K. II. A TRIPLE-PLANET SYSTEM ORBITING HIP 57274

    Doppler observations from Keck Observatory have revealed a triple-planet system orbiting the nearby K4V star, HIP 57274. The inner planet, HIP 57274b, is a super-Earth with Msin i = 11.6 M⊕ (0.036 MJup), an orbital period of 8.135 ± 0.004 days, and slightly eccentric orbit e = 0.19 ± 0.1. We calculate a transit probability of 6.5% for the inner planet. The second planet has Msin i = 0.4 MJup with an orbital period of 32.0 ± 0.02 days in a nearly circular orbit (e = 0.05 ± 0.03). The third planet has Msin i = 0.53 MJup with an orbital period of 432 ± 8 days (1.18 years) and an eccentricity e = 0.23 ± 0.03. This discovery adds to the number of super-Earth mass planets with M sin i ⊕ that have been detected with Doppler surveys. We find that 56% ± 18% of super-Earths are members of multi-planet systems. This is certainly a lower limit because of observational detectability limits, yet significantly higher than the fraction of Jupiter mass exoplanets, 20% ± 8%, that are members of Doppler-detected, multi-planet systems.

  2. Three cases of systemic amyloidosis successfully diagnosed by subcutaneous fat tissue biopsy of the hip

    Arahata, Masahisa; Shimadoi, Shigeru; Yamatani, Satosi; Hayashi, Shin-ichi; Miwa, Shigeharu; Asakura, Hidesaku; Nakao, Shinji

    2016-01-01

    Fine-needle aspiration biopsy of the abdominal fat pad is considered to be a minimally invasive procedure for diagnosing systemic amyloidosis. However, this procedure is sometimes difficult and can be dangerous for elderly patients whose abdominal fat layer is thin because of malnutrition. In such cases, alternative diagnostic methods are required. We report three elderly patients with heart failure complicated by malnutrition. In all cases, electrocardiogram showed low voltage in the limb leads and a pseudoinfarct pattern in the chest leads, and echocardiography showed left ventricular wall thickening with granular sparkling appearance. These patients were suspected of having amyloid cardiomyopathy but could not undergo myocardial biopsies because of their poor conditions. After failed attempts at biopsy of the abdominal fat pad or the other organs, subcutaneous fat tissue biopsy over the hip led to the diagnosis of systemic amyloidosis with cardiomyopathy. The resultant diagnosis guided us to choose the appropriate treatment for the patients. This article illustrates that subcutaneous fat tissue biopsy of the hip could be a useful procedure for diagnosing systemic amyloidosis in elderly patients, particularly when a fat tissue biopsy of the abdomen is associated with a high risk of complications because of malnutrition. PMID:27540285

  3. Wear and degradation of uhmwpe total hip replacement components

    Kipping, Michael

    2009-01-01

    Long term (>2 years) failure of UHMWPE components in-vivo is predominantly caused by wear of the UHMWPE component. The surface properties of UHMWPE greatly influence the adhesive and abrasive mechanisms of wear that occur in the hip. However, there is not a clear understanding of how in-vivo wear mechanisms influence surface mechanical properties of UHMWPE. In addition, previous researchers have reported wear rates for Charnley UHMWPE acetabular components that vary considerably between pati...

  4. Precision of radiostereometric analysis (RSA) of acetabular cup stability and polyethylene wear improved by adding tantalum beads to the liner

    Nebergall, Audrey K; Rader, Kevin; Palm, Henrik;

    2015-01-01

    Background and purpose - In traditional radiostereometric analysis (RSA), 1 segment defines both the acetabular shell and the polyethylene liner. However, inserting beads into the polyethylene liner permits employment of the shell and liner as 2 separate segments, enabling distinct analysis of the...... precision of 3 measurement methods in determining femoral head penetration and shell migration. Patients and methods - The UmRSA program was used to analyze the double examinations of 51 hips to determine if there was a difference in using the shell-only segment, the liner-only segment, or the shell + liner...

  5. Systemic Inflammatory Responses and Lung Injury following Hip Fracture Surgery Increases Susceptibility to Infection in Aged Rats

    Hao Zhang

    2013-01-01

    Full Text Available Pulmonary infections frequently occur following hip fracture surgery in aged patients. However, the underlying reasons are not fully understood. The present study investigates the systemic inflammatory response and pulmonary conditions following hip fracture surgery as a means of identifying risk factors for lung infections using an aged rodent model. Aged, male Sprague-Dawley rats (8 animals per group underwent a sham procedure or hip fracture plus femoral intramedullary pinning. Animals were sacrificed 1, 3, and 7 days after the injury. Markers of systemic inflammation and pulmonary injury were analyzed. Both sham-operated and injured/surgical group animals underwent intratracheal inoculation with Pseudomonas aeruginosa 1, 3, and 7 days after surgery. P. aeruginosa counts in blood and bronchoalveolar lavage (BAL fluid and survival rates were recorded. Serum TNF-α, IL-6, IL-1β, and IL-10 levels and markers of pulmonary injury were significantly increased at 1 and 3 days following hip fracture and surgery. Animals challenged with P. aeruginosa at 1 and 3 days after injury had a significantly decreased survival rate and more P. aeruginosa recovered from blood and BAL fluid. This study shows that hip fracture and surgery in aged rats induced a systemic inflammatory response and lung injury associated with increased susceptibility to infection during the acute phase after injury and surgery.

  6. Infant Hip Joint Diagnostic Support System Based on Clinical Manifestations in X-ray Images

    Honda,Mitsugi

    2010-06-01

    Full Text Available Plain X-ray radiography is frequently used for the diagnosis of developmental dislocation of the hip (DDH. The aim of this study was to construct a diagnostic support system for DDH based on clinical findings obtained from the X-ray images of 154 female infants with confirmed diagnoses made by orthopedists. The data for these subjects were divided into 2 groups. The Min-Max method of nonlinear analysis was applied to the data from Group 1 to construct the diagnostic support system based on the measurement of 4 items in X-ray images:the outward displacement rate, upward displacement rate, OE angle, and alpha angle. This system was then applied to the data from Group 2, and the results were compared between the 2 groups to verify the reliability of the system. We obtained good results that matched the confirmed diagnoses of orthopedists with an accuracy of 85.9%.

  7. A quantitative assessment of facial protection systems in elective hip arthroplasty.

    Hirpara, Kieran Michael

    2011-06-01

    We aimed to assess the risk to surgeons of blood splatter during total hip arthroplasty. Hoods from personal protection systems used in 34 consecutive total hip replacements were collected and the area of blood splatter was measured and compared to goggles and visors. Thirty one primary THA\\'s (13 cemented, 4 hybrid, 14 uncemented) and 3 revisions (1 hybrid, 2 uncemented) were collected. Splashes were detected on all of the masks with a mean of 034% cover. Splatter was greatest for the operating surgeon, followed by the first assistant, though the difference was not statistically significant. Operating personnel were at greater risk of contamination during uncemented arthroplasty (p < 0.0001; 95% CI). On average 50.60% and 45.40% of blood cover was outside the area protected by goggles and visors respectively. There was a significant difference between the Personal Protection Systems (PPS) and goggles (p = 0.0231; 95% CI) as well as between the PPS and visors (p = 0.0293; 95% CI).

  8. Hip Instability: Current Concepts and Treatment Options.

    Dumont, Guillaume D

    2016-07-01

    Instability of the hip can manifest in a wide range of settings, with presenting symptoms including subtle discomfort at end range of motion or more dramatic dislocation of the joint. It can result from traumatic injury with dislocation or subluxation; atraumatic capsular laxity; structural bony abnormality, such as acetabular dysplasia; and iatrogenic injury. Initial treatment of the concentrically reduced joint often begins with physical therapy to strengthen dynamic stabilizers and to allow time for resolution of acute symptoms. Surgical treatment is aimed at repairing injured soft tissue structures, including static stabilizers, and addressing underlying bony structural deficiencies. PMID:27343395

  9. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

    Mladenović Marko

    2015-01-01

    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  10. Isolated hip fracture care in an inclusive trauma system : A trauma system wide evaluation

    van Laarhoven, J. J E M; van Lammeren, G. W.; Houwert, R. M.; van Laarhoven, C. J H C M; Hietbrink, F.; Leenen, L. P H; Verleisdonk, E. J M M

    2015-01-01

    Introduction: Elderly patients with a hip fracture represent a large proportion of the trauma population; however, little is known about outcome differences between different levels of trauma care for these patients. The aim of this study is to analyse the outcome of trauma care in patients with a h

  11. Design and construction of an experimental HIP system comprising in-situ ultrasonic sound wave velocity measurements

    Hot Isostatic Pressing (HIP) is a process used to manufacture engineering components from metallic and ceramic powders, to diffusion-bond materials and to heal defects in castings. Powder densification is performed by encapsulating the powder in a sealed container and applying isostatic pressure at it. The collapsing of the can plastically deforms the powder particles and when temperature is raised, creep and diffusion mechanisms become active. The sintering processes, provided that sufficient time is allowed, lead to a fully dense and pore-free material. In many cases, a material made from powder by HIP, has mechanical properties superior to those manufactured using other methods. The properties of a material produced by HIP is a function of the process parameters - temperature, pressure and time. until quite recently those parameters were set through numerous HIP cycles accompanied by testing the end products to determine their properties. Metallurgical and economical reasons encourage researchers to propose ways for the in-situ monitoring of the processes taking place in the specimen as it is being HIP'ed. Several techniques including the Ashby model or inserting a dilatometer or an eddy current transducer into the pressure vessel are under consideration. A unique system developed at NRCN aimed at the in-situ monitoring of sintering processes is presented. It is based on the continuous measurement of sound wave velocity in the HIP'ed material. The construction of a HIP comprising ultrasonic sound waves velocity measurement facility is described. Some results of experiments in which the relationship between sound velocity and the material's quality are given. (authors)

  12. TREATMENT OF HIP DYSPLASIA

    Iulian ICLEANU

    2015-11-01

    Full Text Available In this thesis, our purpose is to show that using physiotherapy on patients with hip dysplasia from the very beginning, in the first months of life, helps treating them faster. Common literature proposes to use physiotherapy on patients with hip dysplasia either after their recovery or in the terminal phase of recovery, claiming that any earlier intervention will prolong the hip recovery. The effects of hip dysplasia reflect over the whole musculoskeletal system, while it hinders the knees (genu valgum, the ankles (ankle valgus, calcaneal valgus and the spine (scoliosis especially at the lumbar level. The most spectacular are at the hip level, that is why we made an analytical evaluation only for this joint. To show the importance of physiotherapy for children with hip dysplasia we started from the hypothesis: untimely treatment for children with hip dysplasia has improved results in functional recovery and in obtaining a better stability, without the necessity of orthopedics or surgical interventions. The research methods used in this study are: the observation method, the bibliographic study method, the experimental method, the graphics method and the statistical mathematical method to process the data and to represent the results graphically. In the end, the results obtained are significantly different from the initial evaluations and we came to the conclusion that starting an untimely analytical kinetic treatment and globally personalizing it to every patient improves stability and biomechanical parameters for the hip.

  13. DSA-guided percutaneous acetabuloplasty for the treatment of acetabular metastases: a clinical study

    Objective: To discuss the technical points, safety and clinical effectiveness of DSA-guided percutaneous acetabuloplasty (PA) for the treatment of acetabular metastases. Methods: Fifteen patients, including 6 males and 9 females, with acetabular malignant metastases were enrolled in this study. A total of 19 lesions were detected. The lesions were 13-25 mm in size (mean 19 ± 4 mm), the dose of PMMA used for per lesion was 5-13 ml (mean 8.2 ± 2.3 ml). All patients complained of greater or less degree of pain in their hips, 8 patients had to use walking stick, 4 patients showed limping although they could walk independently and three patients could not walk alone. DSA-guided percutaneous acetabuloplasty was performed in all patients and follow-up after the procedure was conducted for 1-12 months. Visual analogue score (VAS), walking state score and analgesic dosage taken by the patients were used for the evaluation of the clinical effectiveness. The complications were analyzed. All the data obtained were statistically analyzed with paired samples t test and analysis of variance by using SPSS12.0 statistical software. Results: The procedure was technically successful in all patients. Pain rating evaluated by the VAS decreased from a mean of 7.8 before surgery to a mean of 4.2 in 24 hours after surgery (P<0.01), which further decreased to 2.5 in one month (P<0.01), while walking state score increased from a mean of 1.5 before surgery to a mean of 2.5 in 24 hours after surgery (P<0.01). The analgesic dosage taken by the patient was reduced in 14 patients and remained the same in one patient. The bone cement leakage into para-acetabular soft tissues occurred in three cases and peripheral vascular exudation of acetabulum was observed in three cases with no obvious clinical symptoms. Conclusion: As a safe, reliable and minimally-invasive technique, DSA-guided percutaneous acetabuloplasty has excellent anti-pain effect in treating acetabular metastases. This therapy can

  14. Sonographic anatomy of the newborn hip and high-resolution US equipments: internal capsular stripe and perichondral gap

    The use of high-resolution US equipments in the examination of the newborn hip allowed the evaluation of a thin echogenic stripe (the internal capsule stripe), which defines laterally the acetabular hyaline cartilage. By means of an anatomo-histological preparation the echogenic stripe can be related to either the capsular circular fibres or the interface between the latter and the hyaline cartilage. The internal capsular stripe, together with the echogenic synovial stripe, precisely delimit the whole acetabular hyaline cartilage. Further-more, in many babies high-resolution US sometimes fails to demonstrate Graft's 'perichondral gap', so that an accurate anatomic knowledge of the hip becomes necessary in the evaluation of acetabular labrum

  15. Supra-Acetabular Brown Tumor due to Primary Hyperparathyroidism Associated with Chronic Renal Failure

    Rosaria M. Ruggeri

    2010-01-01

    Full Text Available A 63-year-old woman presented to the Orthopedic Unit of our hospital complaining of right hip pain of 6 months'duration associated with a worsening limp. Her past medical history included chronic renal insufficiency. Physical examination revealed deep pain in the iliac region and severe restriction of the right hip's articular function in the maximum degrees of range of motion. X-rays and CT scan detected an osteolytic and expansive lesion of the right supra-acetabular region with structural reabsorption of the right iliac wing. 99mTc-MDP whole-body bone scan showed an abnormal uptake in the right iliac region. Bone biopsy revealed an osteolytic lesion with multinucleated giant cells, indicating a brown tumor. Serum intact PTH was elevated (1020 pg/ml; normal values, 12 62 pg/ml, but her serum calcium was normal (total = 9.4 mg/dl, nv 8.5–10.5; ionized = 5.0 mg/dl, nv 4.2–5.4 due to the coexistence of chronic renal failure. 99mTc-MIBI scintigraphy revealed a single focus of sestamibi accumulation in the left retrosternal location, which turned out to be an intrathoracic parathyroid adenoma at surgical exploration. After surgical removal of the parathyroid adenoma, PTH levels decreased to 212 pg/ml. Three months after parathyroidectomy, the imaging studies showed complete recovery of the osteolytic lesion, thus avoiding any orthopedic surgery. This case is noteworthy because (1 primary hyperparathyroidism was not suspected due to the normocalcemia, likely attributable to the coexistence of chronic renal failure; and (2 it was associated with a brown tumor of unusual location (right supra-acetabular region.

  16. Digital subtraction arthrography in preoperative evaluation of painful total hip arthroplasty

    Digital subtraction arthrograms, scintigrams and plain radiographs of 70 consecutive patients who underwent revision hip arthroplasty were scored individually and in masked fashion for the presence or absence of features indicating loosening of femoral and/or acetabular components. The operative findings acted as the gold standard. Digital subtraction arthrography was best for predicting a loose acetabular component, while no significant additional predictive value was found for plain radiographs and scintigraphy. Digital subtraction arthrography was also the most important modality for predicting a loose femoral component, while the plain radiograph was of significant additional value and scintigraphy was of no additional value on multivariate analysis. (orig./MG)

  17. Automatic hip cartilage segmentation from 3D MR images using arc-weighted graph searching

    Accurate segmentation of hip joint cartilage from magnetic resonance (MR) images offers opportunities for quantitative investigations of pathoanatomical conditions such as osteoarthritis. In this paper, we present a fully automatic scheme for the segmentation of the individual femoral and acetabular cartilage plates in the human hip joint from high-resolution 3D MR images. The developed scheme uses an improved optimal multi-object multi-surface graph search framework with an arc-weighted graph representation that incorporates prior morphological knowledge as a basis for segmentation of the individual femoral and acetabular cartilage plates despite weak or incomplete boundary interfaces. This automated scheme was validated against manual segmentations from 3D true fast imaging with steady-state precession (TrueFISP) MR examinations of the right hip joints in 52 asymptomatic volunteers. Compared with expert manual segmentations of the combined, femoral and acetabular cartilage volumes, the automatic scheme obtained mean (± standard deviation) Dice’s similarity coefficients of 0.81 (± 0.03), 0.79 (± 0.03) and 0.72 (± 0.05). The corresponding mean absolute volume difference errors were 8.44% (± 6.36), 9.44% (± 7.19) and 9.05% (± 8.02). The mean absolute differences between manual and automated measures of cartilage thickness for femoral and acetabular cartilage plates were 0.13 mm (± 0.12) and 0.11 mm (± 0.11), respectively. (paper)

  18. Pelvic orientation and assessment of hip dysplasia in adults

    Jacobsen, Steffen; Sonne-Holm, Stig; Lund, B;

    2004-01-01

    on the measurements of radiographic indices of hip dysplasia. MATERIAL AND METHODS: We investigated the effect of varying pelvic orientation on radiographic measurements of acetabular dysplasia using a cadaver model. Results from the cadaver study were used to validate the radiographic assessments of...... pelvic radiograph was recorded at each 3 degrees increment. The most widely used radiographic parameters of hip dysplasia were assessed. 2) Critical limits of acceptable rotation and inclination/reclination of pelvises were determined on 4151 standing, standardised pelvic radiographs of the CCHS cohort......BACKGROUND: The study was performed to qualify the source material of 4151 pelvic radiographs for the research into the relationship between unrecognised childhood hip disorders and the development of hip osteoarthrosis, and to investigate the effect of varying degrees of pelvic tilt and rotation...

  19. CONGENITAL DISLOCATION OF RIGHT HIP JOINT: IMPORTANCE OF DYNAMIC ASSESSMENT

    Pranita viveki

    2014-11-01

    Full Text Available Congenital Dislocation of Hip (CDH, is one of the most common congenital diseases in the orthopedic field. It is also known as Developmental Dysplasia of Hip. The condition can be diagnosed by clinical, ultrasonographic and radiological examination. Here we are reporting two days old male baby with congenital dislocation of right hip joint. The goal of treatment is to obtain a reduction to provide an optimal environment for femoral head and acetabular development. Early diagnosis is the most crucial aspect of the treatment of children with congenital dislocation of hip. If dislocation remains undiagnosed or neglected, the secondary pathological changes take place. Education of primary care colleagues, in making the diagnosis and prompt referral for management is recommended.

  20. Patterns of femoral head migration in osteoarthritis of the hip: A reappraisal using CT and pathologic correlation

    Although superior, medial, and axial patterns of migration of the femoral head in osteoarthritis (OA) of the hip have been well described, it is not clear what anatomic and biomechanical factors determine the direction of migration. To define any relationships between migration in the coronal and the transverse planes, the authors evaluated 22 patients (total of 33 hips with OA) as well as 15 pathologic specimens by conventional radiography and computed tomography. Fourteen of the 19 superiorly migrated hips had an anterior migration component, and five of seven medially migrated hips had a posterior migration component. The authors' cases were also evaluated for femoral anteversion angle, femoral nick-shaft angle, acetabular anteversion, and acetabular inclination, but no correlation with specific migration patterns was evident

  1. Taper Hip Prosthesis

    Full Text Available ... L Taper Hip Prosthesis with Modular Neck Kinectiv® Technology March 12, 2009 7:00 PM EDT Welcome ... hopefully you will see the benefits and the advantages of the new Zimmer Kinectiv System. Thank you. ...

  2. Taper Hip Prosthesis

    Full Text Available ... on the Kinectiv Total Hip System. At this time, let’s join Dr. Maltry in the operating room. ... you show us that leg position one more time? Can we show his front view of how ...

  3. The valve of high-frequency ultrasound in evaluating the growth of hips in patients with suspected developmental dysplasia of hip%高频超声对疑似发育性髋关节异常患儿髋关节发育的评估价值

    陈文娟; 段星星; 李皓; 张雪华; 胡原; 张号绒

    2011-01-01

    Objective To investigate the value of the conventional static ultrasound in the diagnosis of infants who were suspected with developmental dysplasia of hip (DDH). Methods A total of 1224 hips of 612 infants with clinical suspected DDH were evaluated by sonography and dynamic tracked and observate the development situation of hip to evaluate the hip stability according to the Graf method and Morin method. Results In the 1224 hips, 87.4% were morphologically normal hip (type I ) , 9.8% were physiological immature (type Ⅱa), 8.3% were acetabular dysplasia, 4. 3% were critical zone hips (type Ⅱc), 2. 2% were subluxation (type Ⅲ ) , and 2.9% were dislocation (type Ⅳ ). The acetabular bone coverage of 1 035 hips were > 50%, the acetabular bone coverage of 189 hips were 50%,189个关节骨性髋臼覆盖率 < 50%.结论依据 Graf法、Morin法评价髋关节并动态追踪,能降低发育性髋关节异常的过度治疗和治疗延误率.

  4. “Table-less” and “Assistant-less” Direct Anterior Approach to Hip Arthroplasty

    Daniel C Allison

    2015-10-01

    Full Text Available In recent years, specialized, non-sterile, traction table systems have facilitated Direct Anterior Approach (DAA hip arthroplasty. To combat the potential downsides of these traction systems, a sterile, intra-operative retractor option has emerged as a means to access the surgical site more easily, minimize soft-tissue trauma, and reduce the degree of required human assistance. This chapter describes the setup, surgical approach, and early results of a retractor system (the Phantom MIS Anterior Hip Retractor system [TeDan Surgical Innovations, Inc. {TSI}, Houston, Texas, US Patent # 8,808,176 B2], which uses a standard operating table, allows preparation of both lower extremities free in the surgical field, is compatible with fluoroscopy, and aids in both acetabular and femoral exposure, preparation, and implantation. Early outcome data indicates that this system significantly minimizes the need for surgical assistance, while allowing for safe and effective DAA performance, facilitating the procedure for high-volume surgeons and shortening the learning curve for surgeons new to the procedure.

  5. Radiography, radionuclide imaging, and asthrography in the evaluation of total hip and knee replacement

    Twenty patients with 21 total joint replacements including 17 hips and 4 knees were studied by plain film radiography, radionuclide imaging, and subtraction arthrography to evaluate these procedures for assessing prosthetic complications. Surgery was performed in 14 patients and confirmed loosening of 8 femoral and 7 acetabular hip prosthesis components and 1 femoral and 4 tibial knee prosthesis components. Plain films suggested loosening of only 9 hip components and no knee components. In contrast, radionuclide imaging and subtraction arthrography were considerably more effective in demonstrating loosening as well as other causes of the painful total joint prosthesis

  6. A new holder and surface MRI coil for the examination of the newborn infant hip

    A special holder was developed for examination of the infant hip joint using MRI. This holder allows the infant hip joint to be examined both in a neutral position and in various defined functional positions. A special integrated surface coil, also developed for this purpose, provides the high spatial resolution required for assessment of the fine joint structures. Thirty infants were examined and the new device has proved useful in advanced hip dysplasia, therapy-resistant subluxation and luxation, and for operative therapy planning (reconstruction of the acetabular roof, redirectional osteotomies). Interpretation errors due to misprojection can be eliminated to a large extent since the holder allows standardized and reproducible positioning. (orig.)

  7. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Hassan Rahimi

    2013-09-01

    Full Text Available   Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  8. Surgical advances in periacetabular osteotomy for treatment of hip dysplasia in adults

    Troelsen, Anders

    2009-01-01

    Hip dysplasia is characterized by an excessively oblique and shallow acetabulum with insufficient coverage of the femoral head. It is a known cause of pain and the development of early osteoarthritis in young adults. The periacetabular osteotomy is the joint-preserving treatment of choice in young...... adults with symptomatic hip dysplasia. The surgical aim of this extensive procedure is to reorient the acetabulum to improve coverage and eliminate the pathological hip joint mechanics. Intraoperative assessment of the achieved acetabular reorientation is therefore crucial. The "classic" surgical...

  9. Full Text Available ... 30/2011) Hip Replacement with Acetabular System and Modular Neck Technology (Hackensack University Medical Center, Hackensack, NJ, ... 30/2011) Hip Replacement with Acetabular System and Modular Neck Technology (Hackensack University Medical Center, Hackensack, NJ, ...

  10. Full Text Available ... Hip Replacement with Acetabular System and Modular Neck Technology (Hackensack University Medical Center, Hackensack, NJ, 9/23/ ... Hip Replacement with Acetabular System and Modular Neck Technology (Hackensack University Medical Center, Hackensack, NJ, 9/23/ ...

  11. The effect of geometry and abduction angle on the stresses in cemented UHMWPE acetabular cups – finite element simulations and experimental tests

    Santavirta Seppo S

    2005-05-01

    Full Text Available Abstract Background Contact pressure of UHMWPE acetabular cup has been shown to correlate with wear in total hip replacement (THR. The aim of the present study was to test the hypotheses that the cup geometry, abduction angle, thickness and clearance can modify the stresses in cemented polyethylene cups. Methods Acetabular cups with different geometries (Link®: IP and Lubinus eccentric were tested cyclically in a simulator at 45° and 60° abduction angles. Finite element (FE meshes were generated and two additional designs were reconstructed to test the effects of the cup clearance and thickness. Contact pressures at cup-head and cup-cement interfaces were calculated as a function of loading force at 45°, 60° and 80° abduction angles. Results At the cup-head interface, IP experienced lower contact pressures than the Lubinus eccentric at low loading forces. However, at higher loading forces, much higher contact pressures were produced on the surface of IP cup. An increase in the abduction angle increased contact pressure in the IP model, but this did not occur to any major extent with the Lubinus eccentric model. At the cup-cement interface, IP experienced lower contact pressures. Increased clearance between cup and head increased contact pressure both at cup-head and cup-cement interfaces, whereas a decreased thickness of polyethylene layer increased contact pressure only at the cup-cement interface. FE results were consistent with experimental tests and acetabular cup deformations. Conclusion FE analyses showed that geometrical design, thickness and abduction angle of the acetabular cup, as well as the clearance between the cup and head do change significantly the mechanical stresses experienced by a cemented UHMWPE acetabular cup. These factors should be taken into account in future development of THR prostheses. FE technique is a useful tool with which to address these issues.

  12. Three-fin acetabular prosthesis for superior acetabular bone defects: a three-dimensional finite element analysis

    LIU Yu-zeng; HAI Yong; ZHAO Hui

    2012-01-01

    Background Given that three-dimensional finite element models have been successfully used to analyze biomechanics in orthopedics-related research,this study aimed to establish a finite element model of the pelvic bone and three-fin acetabular component and evaluate biomechanical changes in this model after implantation of a three-fin acetabular prosthesis in a superior segmental bone defect of the acetabulum.Methods In this study,three-dimensional finite element models of the pelvic bone and three-fin acetabular component were first established.The prosthesis model was characterized by three different conformational fins to facilitate and optimize the prosthetic design.The spongy and cortical bones were evaluated using a different modulus of elasticity in this established model.Results The maximum and minimum von Mises stresses on the fins of the acetabular component were 15.2 and 0.74,respectively.The maximum and minimum micromotion between the three-fin acetabular component and the acetabulum bone interface were 27 and 13 μm,respectively.A high primary stability and implied better clinical outcome were revealed.Conclusion Finite element analysis may be an optimal strategy for biomechanics-related research of prosthetic design for segmental acetabular bone defects.

  13. Validation of a Kinect-based telerehabilitation system with total hip replacement patients.

    Antón, David; Nelson, Mark; Russell, Trevor; Goñi, Alfredo; Illarramendi, Arantza

    2016-04-01

    The evolving telecommunications industry combined with medical information technology has been proposed as a solution to reduce health care cost and provide remote medical services. This paper aims to validate and show the feasibility and user acceptance of using a telerehabilitation system called Kinect Rehabilitation System (KiReS) in a real scenario, with patients attending repeated rehabilitation sessions after they had a Total Hip Replacement (THR). We present the main features of KiReS, how it was set up in the considered scenario and the experimental results obtained in relation to two different perspectives: patients' subjective perceptions (gathered through questionnaires) and the accuracy of the performed exercises (by analysing the data captured using KiReS). We made a full deployment of KiReS, defining step by step all the elements of a therapy: postures, movements, exercises and the therapy itself. Seven patients participated in this trial in a total of 19 sessions, and the system recorded 3865 exercise executions. The group showed general support for telerehabilitation and the possibilities that systems such as KiReS bring to physiotherapy treatment. PMID:26130735

  14. Experimental and Monte Carlo evaluation of Eclipse treatment planning system for effects on dose distribution of the hip prostheses

    Çatlı, Serap, E-mail: serapcatli@hotmail.com [Gazi University, Faculty of Sciences, 06500 Teknikokullar, Ankara (Turkey); Tanır, Güneş [Gazi University, Faculty of Sciences, 06500 Teknikokullar, Ankara (Turkey)

    2013-10-01

    The present study aimed to investigate the effects of titanium, titanium alloy, and stainless steel hip prostheses on dose distribution based on the Monte Carlo simulation method, as well as the accuracy of the Eclipse treatment planning system (TPS) at 6 and 18 MV photon energies. In the present study the pencil beam convolution (PBC) method implemented in the Eclipse TPS was compared to the Monte Carlo method and ionization chamber measurements. The present findings show that if high-Z material is used in prosthesis, large dose changes can occur due to scattering. The variance in dose observed in the present study was dependent on material type, density, and atomic number, as well as photon energy; as photon energy increased back scattering decreased. The dose perturbation effect of hip prostheses was significant and could not be predicted accurately by the PBC method for hip prostheses. The findings show that for accurate dose calculation the Monte Carlo-based TPS should be used in patients with hip prostheses.

  15. Calculating the hip center of rotation using contralateral pelvic anatomy.

    Durand-Hill, Matthieu; Henckel, Johann; Satchithananda, Keshthra; Sabah, Shiraz; Hua, Jia; Hothi, Harry; Langstaff, Ronald J; Skinner, John; Hart, Alister

    2016-06-01

    Failure to place an artificial hip in the optimal center of rotation results in poor hip function and costly complications. The aim of this study was to develop robust methodology to estimate hip center of rotation (hCoR) from preoperative computed tomography (CT) scans, using contralateral anatomy, in patients with unilateral diseased hips. Ten patients (five male, five female) with normal pelvic anatomy, and one patient with a unilateral dysplastic acetabulum were recruited from the London Implant Retrieval center image bank. 3D models of each pelvis were generated using commercial software. Two methods for estimation of hCoR were compared. Method 1 used a mirroring technique alone. Method 2 utilized mirroring and automatic alignment. Predicted versus actual hCoR co-ordinates were compared using intraclass correlation coefficients and paired T-tests. Both methods predicted hCoR with excellent agreement to original co-ordinates (>0.9) in all axes. Both techniques allowed prediction of the hCoR within ± 5 mm in all axes. Both techniques provided useful clinical information for planning acetabular reconstruction in patients with unilateral defects. Method 1 was less complex and is suitable for patients with developmental and degenerative pathologies. Method 2 may provide greater accuracy in a discrete group of patients with normal development prior to pathology (e.g., acetabular fractures). © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1077-1083, 2016. PMID:26630078

  16. A new classification for 'Pistol Grip Deformity'. Correlation between the severity of the deformity and the grade of osteoarthritis of the hip

    Ipach, Ingmar; Mittag, F.; Sachsenmaier, S.; Kluba, T. [Tuebingen Univ. (Germany). Dept. of Orthopaedic Surgery; Heinrich, P. [Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany). Inst. fuer Medizinische Statistik und Epidemiologie

    2011-04-15

    Purpose: Two types of femoroacetabular impingement (FAI) are described as reasons for the early development of osteoarthritis of the hip. Cam impingement develops from contact between an abnormal head-neck junction and the acetabular rim. Pincer impingement is characterized by local or general overcoverage of the femoral head by the acetabular rim. Both forms might cause early osteoarthritis of the hip. A decreased head/neck offset has been recognized on AP pelvic views and labeled as 'pistol grip deformity'. The aim of the study was to develop a classification for this deformity with regard to the stage of osteoarthritis of the hip. Materials and Methods: 76 pelvic and axial views were analyzed for alpha angle and head ratio. 22 of them had a normal shape in the head-neck region and no osteoarthritis signs, 27 had a 'pistol grip deformity' and osteoarthritis I and 27 had a 'pistol grip deformity' and osteoarthritis II -IV . The CART method was used to develop a classification. Results: There was a statistically significant correlation between alpha angle and head ratio. A statistically significant difference in alpha angle and head ratio was seen between the three groups. Using the CART method, we developed a three-step classification system for the 'pistol grip deformity' with very high accuracy. This deformity was aggravated by increasing age. Conclusion: Using this model it is possible to differentiate between normal shapes of the head-neck junction and different severities of the pistol grip deformity. (orig.)

  17. Microinstability of the Hip and the Splits Radiograph.

    Harris, Joshua D; Gerrie, Brayden J; Lintner, David M; Varner, Kevin E; McCulloch, Patrick C

    2016-01-01

    A normal hip has a natural tendency toward stability because of both osseous and soft tissue structures. Hip motion is primarily rotational around a center of rotation. When the femoral head and its center of rotation translate, with or without rotation, the inherent stability of the femoroacetabular articulation may be lost. The spectrum of hip instability ranges from subtle microinstability to traumatic dislocation. Microinstability may be the cause or the effect of several other hip pathologies. Soft tissue contributions to stability include the static capsule, dynamic musculotendinous units, and underlying generalized connective tissue (eg, Ehlers-Danlos). Osseous contributions include multiple femoral and acetabular radiographic coverage parameters. Iatrogenic contributions include an unrepaired capsulotomy, overresection of the acetabular rim (iatrogenic dysplasia), overresection of cam osteochondroplasty, iliopsoas tenotomy, labral debridement, and ligamentum teres debridement. Patients with hip microinstability often have deep groin pain, exhibited by a C sign. These patients frequently participate in flexibility sports and activities, such as ballet, gymnastics, figure skating, and martial arts. On physical examination, generalized hypermobility syndromes should be assessed, as should loss of log-roll external rotation recoil, excessive abduction, trochanteric-pelvic impingement, and abductor fatigue. Standard imaging, including plain radiographs, magnetic resonance imaging, and computed tomography, should be analyzed for all causes of hip pain. A new plain radiograph, the splits radiograph is introduced here, consistently showing lateral femoral head translation and creation of a vacuum sign, showing hip microinstability. The splits radiograph is illustrated in a 22-year-old female dancer who presented with bilateral deep anterolateral groin pain. PMID:26730687

  18. The Arterial Folding Point During Flexion of the Hip Joint

    Purpose: Endovascular stents placed in periarticular vessels may be at a greater risk of neointimal hyperplasia and eventual occlusion than those placed in non-periarticular vessels. The purpose of this study was to investigate the location of maximal conformational change along the iliac and femoral artery, the folding point, during flexion of the hip joint and its location relative to the hip joint and the inguinal ligament. Methods: Seventy patients undergoing femoral artery catheterization were evaluated. The patients were 47 men and 23 women and ranged in age from 26 to 75 years (mean 54 years). The arteries (right:left = 34:36) were measured using a marked catheter for sizing vessels. Fluoroscopic images were obtained in anteroposterior and lateral projections in neutral position, and in the lateral projection in flexed position of the hip joint. The folding point was determined by comparing the lateral projection images in the neutral and flexed positions. The distance from the acetabular roof to the folding point and the distance from the inguinal ligament to the folding point was evaluated. Results: : The folding point was located 42.8 ± 28.6 mm cranial to the acetabular roof and 35.1 ± 30.1 mm cranial to the inguinal ligament. As the patient’s age increased, the folding point was located more cranially (p < 0.001). Conclusions: The folding point during flexion of the hip joint was located 42.8 ± 28.6 mm cranial to the acetabular roof and 35.1 ± 30.1 mm cranial to the inguinal ligament. As the patient's age increased, the folding point was located more cranially. When a stent is inserted over this region, more attention may be needed during follow-up to monitor possible occlusion and stent failure.

  19. MR arthrography of the hip joint

    MR arthrography of the hip joint is usually performed after a conventional MRI has been obtained to rule out other pathologies of the hip joint as for instance bone marrow edema or osteonecrosis of the hip. MR arthrography is mainly performed as a very special investigation, and it is executed in most cases if the clinician asks for the diagnosis of a labral lesion. In very rare cases, MR arthrography of the hip is performed to image cartilage disease or osteochondrosis dissecans or free intraarticular bodies. In this paper, the indications, the technique, and the most important pathology of the hip joint - labral lesions - will be described as well as variants of the normal acetabular labrum. After a conventional MRI of the hip joint has been performed, a MR arthrography of the hip will be obtained to search for labral pathology or cartilage disease. MR arthrography is obtained after the intraarticular injection of 10-20 ml of a 0.1 mmol solution of gadopentate-dimeglumine has been performed. The intraarticular injection can either be fluoroscopic-guided or CT-guided or directly MR-guided. After the intraarticular injection, MR arthrography will be performed by the use of paracoronal and parasagittal T1-weighted spin echo or gradient echo sequences. In cases of labral lesions (degeneration, labral tear, labral detachment) or cartilage disease MR arthrography proved to be more sensitive as conventional MRI as shown in the literature. The sensitivity of MRI to detect labral pathology was reported to be about 65%, and that of MR arthrography was reported to be about 92-95% compared to surgical results. According to the current literature, MR arthrography is the most sensitive method to delineate these kind of pathologies. Therefore, the invasive technique of MR arthrography may be justified for the correct diagnosis of these kind of pathologies after other pathologic entities have been ruled out by conventional MRI. (orig.)

  20. Explicit finite element modelling of the impaction of metal press-fit acetabular components.

    Hothi, H S; Busfield, J J C; Shelton, J C

    2011-03-01

    Metal press-fit cups and shells are widely used in hip resurfacing and total hip replacement procedures. These acetabular components are inserted into a reamed acetabula cavity by either impacting their inner polar surface (shells) or outer rim (cups). Two-dimensional explicit dynamics axisymmetric finite element models were developed to simulate these impaction methods. Greater impact velocities were needed to insert the components when the interference fit was increased; a minimum velocity of 2 m/s was required to fully seat a component with a 2 mm interference between the bone and outer diameter. Changing the component material from cobalt-chromium to titanium alloy resulted in a reduction in the number of impacts on the pole to seat it from 14 to nine. Of greatest significance, it was found that locking a rigid cap to the cup or shell rim resulted in up to nine fewer impactions being necessary to seat it than impacting directly on the polar surface or using a cap free from the rim of the component, as is the case with many commercial resurfacing cup impaction devices currently used. This is important to impactor design and could make insertion easier and also reduce acetabula bone damage. PMID:21485331

  1. Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3 T: A prospective controlled study

    Purpose: To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage. Methods and materials: A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8 ± 10.2 years, range: 18–57 years) with different hip joint deformities including femoroacetabular impingement (n = 35), residual hip dysplasia (n = 3) and coxa magna due to Legg–Calve–Perthes disease in childhood (n = 2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5 ± 1.8 years, range: 21–29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1Gd assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions. Results: T1Gd mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1Gd values were significantly higher in the control group than in the patient group whereas significant differences in T1Gd values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group. Conclusions: Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.

  2. Three-dimensional delayed gadolinium-enhanced magnetic resonance imaging of hip joint cartilage at 3 T: A prospective controlled study

    Zilkens, Christoph, E-mail: christoph.zilkens@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Miese, Falk, E-mail: falk.miese@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Kim, Young-Jo, E-mail: young-jo.kim@childrens.harvard.edu [Department of Orthopaedic Surgery, The Children' s Hospital Boston, 300 Longwood Ave., Boston, MA 02115 (United States); Hosalkar, Harish, E-mail: hhosalkar@rchsd.org [Department of Orthopaedic Surgery, Rady Children' s Hospital San Diego, 3030 Childrens Way Ste 410, San Diego, CA 92123 (United States); Antoch, Gerald, E-mail: antoch@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Krauspe, Ruediger, E-mail: krauspe@med.uni-duesseldorf.de [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany); Bittersohl, Bernd, E-mail: bbittersohl@partners.org [Univ. Dusseldorf, Medical Faculty, Department of Orthopaedic Surgery, Moorenstrasse 5, D-40225 Dusseldorf (Germany)

    2012-11-15

    Purpose: To assess acetabular and femoral hip joint cartilage with three-dimensional (3D) delayed gadolinium-enhanced magnetic resonance imaging (dGEMRIC) in patients with degeneration of hip joint cartilage and asymptomatic controls with morphologically normal appearing cartilage. Methods and materials: A total of 40 symptomatic patients (18 males, 22 females; mean age: 32.8 {+-} 10.2 years, range: 18-57 years) with different hip joint deformities including femoroacetabular impingement (n = 35), residual hip dysplasia (n = 3) and coxa magna due to Legg-Calve-Perthes disease in childhood (n = 2) underwent high-resolution 3D dGEMRIC for the evaluation of acetabular and femoral hip joint cartilage. Thirty-one asymptomatic healthy volunteers (12 males, 19 females; mean age: 24.5 {+-} 1.8 years, range: 21-29 years) without underlying hip deformities were included as control. MRI was performed at 3 T using a body matrix phased array coil. Region of interest (ROI) analyses for T1{sub Gd} assessment was performed in seven regions in the hip joint, including anterior to superior and posterior regions. Results: T1{sub Gd} mapping demonstrated the typical pattern of acetabular cartilage consistent with a higher glycosaminoglycan (GAG) content in the main weight-bearing area. T1{sub Gd} values were significantly higher in the control group than in the patient group whereas significant differences in T1{sub Gd} values corresponding to the amount of cartilage damage were noted both in the patient group and in the control group. Conclusions: Our study demonstrates the potential of high-resolution 3D dGEMRIC at 3 T for separate acetabular and femoral hip joint cartilage assessment in various forms of hip joint deformities.

  3. Deformation of the Durom acetabular component and its impact on tribology in a cadaveric model--a simulator study.

    Feng Liu

    Full Text Available BACKGROUND: Recent studies have shown that the acetabular component frequently becomes deformed during press-fit insertion. The aim of this study was to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the Durom large head metal-on-metal (MOM total hips in simulators. METHODS: Six Durom cups impacted into reamed acetabula of fresh cadavers were used as the experimental group and another 6 size-paired intact Durom cups constituted the control group. All 12 Durom MOM total hips were put through a 3 million cycle (MC wear test in simulators. RESULTS: The 6 cups in the experimental group were all deformed, with a mean deformation of 41.78 ± 8.86 µm. The average volumetric wear rate in the experimental group and in the control group in the first million cycle was 6.65 ± 0.29 mm(3/MC and 0.89 ± 0.04 mm(3/MC (t = 48.43, p = 0.000. The ion levels of Cr and Co in the experimental group were also higher than those in the control group before 2.0 MC. However there was no difference in the ion levels between 2.0 and 3.0 MC. CONCLUSIONS: This finding implies that the non-modular acetabular component of Durom total hip prosthesis is likely to become deformed during press-fit insertion, and that the deformation will result in increased volumetric wear and increased ion release. CLINICAL RELEVANCE: This study was determined to explore the deformation of the Durom cup after implantation and to clarify the impact of deformation on wear and ion release of the prosthesis. Deformation of the cup after implantation increases the wear of MOM bearings and the resulting ion levels. The clinical use of the Durom large head prosthesis should be with great care.

  4. Hip Revision

    Full Text Available ... radiograph, unfortunately, three years down the line, this patient was developing increasing hip pain. And you can ... you on the x-rays, this was a patient that had an infection; and we treated this ...

  5. Hip ultrasound

    Martinoli, Carlo, E-mail: carlo.martinoli@libero.it [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa [Radiologia, DISC, Università di Genova, Largo Rosanna Benzi 8, I-16132 Genoa (Italy); Valle, Maura [Radiologia, Gaslini Children Hospital, Genova (Italy); Tagliafico, Alberto [Radiologia, National Institute for Cancer Research, Genoa (Italy)

    2012-12-15

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up.

  6. Hip arthroscopy

    Henrique Antônio Berwanger de Amorim Cabrita

    2015-06-01

    Full Text Available Hip arthroscopy is a safe method for treating a variety of pathological conditions that were unknown until a decade ago. Femoroacetabular impingement is the commonest of these pathological conditions and the one with the best results when treated early on. The instruments and surgical technique for hip arthroscopy continue to evolve. New indications for hip arthroscopy has been studied as the ligamentum teres injuries, capsular repair in instabilities, dissection of the sciatic nerve and repair of gluteal muscles tears (injuries to the hip rotator cuff, although still with debatable reproducibility. The complication rate is low, and ever-better results with fewer complications should be expected with the progression of the learning curve.

  7. Hip ultrasound.

    Martinoli, Carlo; Garello, Isabella; Marchetti, Alessandra; Palmieri, Federigo; Altafini, Luisa; Valle, Maura; Tagliafico, Alberto

    2012-12-01

    In newborns, US has an established role in the detection and management of developmental dysplasia of the hip. Later in childhood, when the limping child is a major diagnostic dilemma, US is extremely helpful in the identification of the varied disease processes underlying this condition, as transient synovitis, septic arthritis, Perthes disease and slipped femoral capital epiphysis. In adolescent practicing sporting activities, US is an excellent means to identify apophyseal injures about the pelvic ring, especially when avulsions are undisplaced and difficult-to-see radiographically. Later on, in the adulthood, US is an effective modality to diagnose tendon and muscle injuries about the hip and pelvis, identify effusion or synovitis within the hip joint or its adjacent bursae and guide the treatment of these findings. The aim of this article is to provide a comprehensive review of the most common pathologic conditions about the hip, in which the contribution of US is relevant for the diagnostic work-up. PMID:21571471

  8. Hip and pelvis diseases on lumbar AP radiographs including both hip joints

    To determine the frequency of diseases of the hip and pelvis, as seen of plain radiography of the lumbar spine in patients with suspicious lumbar disease, and to evaluate the methods used of lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1252 patients, taken using 14' x 17' film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesions, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesions in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 of the 20 hospitals which responded, 14' x 17' film was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful was to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis

  9. The application of MRI in the infantile congenital dislocation of the hip

    Objective: To evaluate the efficacy of MRI in infantile congenital dislocation of the hip (CDH), and to provide a reasonable basis for clinical examination. Methods: Forty-seven infants (< 3 years) with untreated CDH were examined by using MR imaging. Three types were classified according to the standard of Ogden and Dunn, and then the bony and cartilaginous hip parameters of all hips, including the bony acetabular index (BAI), cartilaginous acetabular index (CAI), bony acetabular quotient (BAQ), and cartilaginous acetabular quotient (CAQ), were measured except in the type III hips. Results: For the normal hips, dislocated hips, the type I hips, and the type II hips, BAI was (25.24 ± 3.70) degree, (38.12 ± 4.07) degree, (35.59 ± 2.86) degree, and (39.64 ± 3.97) degree, respectively, CAI was (8.49 ± 2.15) degree, (17.25 ± 2.41) degree, (15.85 ± 2.00) degree, and (18.08 ± 2.26) degree, respectively, BAQ was 0.199 ± 0.026, 0.126 ± 0.028, 0.131 ± 0.028, and 0.124 ± 0.028, respectively, CAQ was 0.195 ± 0.027, 0.120 ± 0.027, 0.120 ± 0.023, and 0.121 ± 0.030, respectively. The BAI and CAI of the type II hips were higher than those of the type I, and BAQ and CAQ were lower. There was a linear correlation between BAI and CAI (r=0.876) and between BAQ and CAQ (r=0.706), respectively. MRI demonstrated that bony changes as loss of sphericity and diminished aperture of the acetabulum, and cartilage changes as the distortion and overgrowth in CDH. Conclusion: MR imaging is not only a very useful imaging modality for assessment of the bony, cartilaginous, and soft-tissue structures of the infantile hip, but also an excellent tool in the diagnosis and treatment of CDH. (author)

  10. MRI of the hip joint; MRT des Hueftgelenks

    Czerny, C.; Noebauer-Huhmann, I.M.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, Medizinische Univ. Wien (Austria)

    2005-12-01

    Magnetic resonance imaging (MRI) is performed to diagnose many pathologic conditions affecting the hip joint. Either conventional MRI (without contrast enhancement of the joint cavity) or MR arthrography is used to detect and most accurately differentiate hip joint pathologies. Conventional MRI is performed in cases of bone marrow edema, necrosis, arthrosis and especially the so-called ''activated arthrosis'', as well as in inflammatory and tumorous entities. MR arthography, which has only recently become available for use, is excellently suited for diagnosing lesions of the acetabular labrum, cartilage lesions, and free articular bodies. This article provides an overview about MRI characteristics and their accuracy of hip joint diseases and the impact on the therapeutic procedure. (orig.)

  11. Assessment of hip dysplasia and osteoarthritis: Variability of different methods

    Troelsen, Anders; Elmengaard, Brian; Soeballe, Kjeld (Orthopedic Research Unit, Univ. Hospital of Aarhus, Aarhus (Denmark)), e-mail: a_troelsen@hotmail.com; Roemer, Lone (Dept. of Radiology, Univ. Hospital of Aarhus, Aarhus (Denmark)); Kring, Soeren (Dept. of Orthopedic Surgery, Aabenraa Hospital, Aabenraa (Denmark))

    2010-03-15

    Background: Reliable assessment of hip dysplasia and osteoarthritis is crucial in young adults who may benefit from joint-preserving surgery. Purpose: To investigate the variability of different methods for diagnostic assessment of hip dysplasia and osteoarthritis. Material and Methods: By each of four observers, two assessments were done by vision and two by angle construction. For both methods, the intra- and interobserver variability of center-edge and acetabular index angle assessment were analyzed. The observers' ability to diagnose hip dysplasia and osteoarthritis were assessed. All measures were compared to those made on computed tomography scan. Results: Intra- and interobserver variability of angle assessment was less when angles were drawn compared with assessment by vision, and the observers' ability to diagnose hip dysplasia improved when angles were drawn. Assessment of osteoarthritis in general showed poor agreement with findings on computed tomography scan. Conclusion: We recommend that angles always should be drawn for assessment of hip dysplasia on pelvic radiographs. Given the inherent variability of diagnostic assessment of hip dysplasia, a computed tomography scan could be considered in patients with relevant hip symptoms and a center-edge angle between 20 deg and 30 deg. Osteoarthritis should be assessed by measuring the joint space width or by classifying the Toennis grade as either 0-1 or 2-3

  12. 膝内外翻畸形时髋臼负重顶区的生物力学变化*★%Biomechanical changes in the acetabular dome region to knee joint varus and valgus

    汤敏生; 白波; 谢诗涓; 龙浩; 刘琦; 陈艺

    2013-01-01

    stress, and the peak stress in the acetabular dome region were measured with pressure sensitive film system. RESULTS AND CONCLUSION:The loading area of tibiofemoral articular surface in the acetabular dome region under the neutral position was (6.33±0.12) cm2, the mean stress was (3.62±0.33) MPa and the peak stress was (4.58±0.20) MPa. When the knee joint varus and valgus for 10°, the loading area in the acetabular dome region was decreased, while the mean stress and peak stress were significantly increased, but the difference between varus and valgus 10° was no significant (P>0.05);when the knee joint varus and valgus for 20°, loading area in the acetabular dome region was significantly decreased, while the mean stress and peak stress were significantly increased, and there was significant difference between varus and valgus 20° (P<0.01). The loading area, mean stress and the peak stress distribution in hip dome region were changed with the tendency of knee varus and valgus increasing. When the knee joint varus and valgus for 20°, the loading area in the acetabular dome region was significantly decreased, while the mean stress and peak stress were significantly increased, this may be one of the factors of hip osteoarthritis caused by knee varus and valgus. Therefore, we should pay attention on the early intervention to the patients with knee osteoarthritis varus and valgus deformity in clinic.

  13. Early Defect Detection of Acetabular Implants

    Kytýř, Daniel; Jiroušek, Ondřej; Zlámal, Petr; Doktor, Tomáš; Jandejsek, I.

    Prague : ITAM AS CR, 2012 - (Náprstek, J.; Fischer, C.), s. 825-834 ISBN 978-80-86246-40-6. [Engineering Mechanics 2012 /18./. Svratka (CZ), 14.05.2012-17.05.2012] R&D Projects: GA ČR(CZ) GAP105/10/2305 Institutional support: RVO:68378297 Keywords : bone-cement interface * computed tomography * crack detection * hip simulator Subject RIV: FI - Traumatology, Orthopedics http://www.engmech.cz/

  14. Good performance of a titanium femoral component in cementless hip arthroplasty in younger patients: 97 arthroplasties followed for 5-11 years

    Jacobsen, Steffen; Jensen, Frank Krieger; Poulsen, Klaus;

    2003-01-01

    We performed 97 uncemented primary total hip arthroplasties in 80 patients having an average age of 50 years. The femoral implant was a titanium stem with a proximal circumferential plasma spray-coating. Three different acetabular components were used: a threaded and partly porous-coated design i...

  15. More than 50% reduction of wear in polyethylene liners with alumina heads compared to cobalt-chrome heads in hip replacements

    Dahl, Jon; Snorrason, Finnur; Nordsletten, Lars; Röhrl, Stephan M

    2013-01-01

    Background and purpose Excessive wear of acetabular liners in hip replacements may lead to osteolysis and cup loosening. Different head materials are currently used. We measured differences in wear between alumina and cobalt-chrome heads with the same polyethylene liner. Patients and methods 39 patients (43 hips) with osteoarthritis were included in a study with 10-year follow-up. Wear was measured as proximal and 3D penetration of the head in the liner with radiostereometry (RSA). All the pa...

  16. Radiographic changes in the hip joint in children suffering from Perthes disease.

    Froberg, Lonnie; Christensen, Finn; Pedersen, Niels Wisbech; Overgaard, Søren

    2012-05-01

    The purpose was to compare radiographic parameters with a sex-matched and age-matched control group at the onset of disease and at skeletal maturity. The study comprised 143 patients with Legg-Calvé-Perthes disease, treated using a Thomas splint. Wiberg's centre-edge angle and the acetabular index angle were applied. The age at diagnosis was 6.6 years with no difference between boys and girls. At the time of diagnosis, the centre-edge angle was decreased from 18° in the control group to 10° in the affected hip. The age at follow-up was 16 (SD 2) years for the boys and 15 (SD 3) years for the girls. At the time of skeletal maturity, the centre-edge angle was decreased and the acetabular index angle increased in the affected hip and the nonaffected hip in Stulberg class III/IV/V hips compared with the control group. Initially radiographic changes only occur on the affected hip. At skeletal maturity both hips show radiographic changes. PMID:22186707

  17. Rehabilitation following hip arthroscopy - A systematic review

    Jeffrey S Grzybowski

    2015-05-01

    Full Text Available CONTEXT: Rehabilitation following hip arthroscopy is an integral component of the clinical outcome of the procedure. Given the increase in quantity, complexity, and diversity of procedures performed, a need exists to define the role of rehabilitation following hip arthroscopy.OBJECTIVES: 1 To determine the current rehabilitation protocols utilized following hip arthroscopy in the current literature, 2 to determine if clinical outcomes are significantly different based on different post-operative rehabilitation protocols; and 3 to propose the best-available evidence-based rehabilitation program following hip arthroscopy.DATA SOURCES: Per PRISMA guidelines and checklist, Medline, SciVerse Scopus, SportDiscus, and Cochrane Central Register of Controlled Trials were searched.STUDY SELECTION: Level I-IV evidence clinical studies with minimum two-year follow-up reporting outcomes of hip arthroscopy with post-operative rehabilitation protocols described were included. DATA EXTRACTION: All study, subject, and surgery parameters were collected. All elements of rehabilitation were extracted and analyzed. Descriptive statistics were calculated. Study methodological quality was analyzed using the Modified Coleman Methodology Score (MCMS.RESULTS: 18 studies were included (2,092 subjects; 52% male, mean age 35.1 +/- 10.6 years, mean follow-up 3.2 +/- 1.0 years. Labral tear and femoroacetabular impingement were the most common diagnoses treated and labral debridement and femoral/acetabular osteochondroplasty the most common surgical techniques performed. Rehabilitation protocol parameters (weight-bearing, motion, strengthening, and return-to-sport were poorly reported. Differences in clinical outcomes were unable to be assessed given heterogeneity in study reporting. Time-, phase-, goal-, and precaution-based guidelines were extracted and reported.CONCLUSIONS: The current literature of hip arthroscopy rehabilitation lacks high-quality evidence to support a

  18. The Immediate Intramedullary Nailing Surgery Increased the Mitochondrial DNA Release That Aggravated Systemic Inflammatory Response and Lung Injury Induced by Elderly Hip Fracture

    Li Gan

    2015-01-01

    Full Text Available Conventional concept suggests that immediate surgery is the optimal choice for elderly hip fracture patients; however, few studies focus on the adverse effect of immediate surgery. This study aims to examine the adverse effect of immediate surgery, as well as to explore the meaning of mtDNA release after trauma. In the experiment, elderly rats, respectively, received hip fracture operations or hip fracture plus intramedullary nail surgery. After fracture operations, the serum mtDNA levels as well as the related indicators of systemic inflammatory response and lung injury significantly increased in the rats. After immediate surgery, the above variables were further increased. The serum mtDNA levels were significantly related with the serum cytokine (TNF-α and IL-10 levels and pulmonary histological score. In order to identify the meaning of mtDNA release following hip fracture, the elderly rats received injections with mtDNA. After treatment, the related indicators of systemic inflammatory response and lung injury significantly increased in the rats. These results demonstrated that the immediate surgery increased the mtDNA release that could aggravate systemic inflammatory response and lung injury induced by elderly hip fracture; serum mtDNA might serve as a potential biomarker of systemic inflammatory response and lung injury following elderly hip fracture.

  19. MRI findings of the residual subluxation after reduction of developmental dysplasia of the hip

    After reduction of developmental dysplasia of the hip (DDH), not a few patients suffer from residual subluxation as well as acetabular dysplasia. Corrective surgery for these residual subluxations is sometimes performed before school-child age. It is occasionally difficult to determine whether the patient is candidate for the corrective surgery in the case with minor morphologic aberration. Therefore, we studied various MRI findings in residual subluxation, and examined if these MRI findings have an effect on natural courses such as growth or concentricity of the hip joint after reduction for DDH. The usefulness of MRI for determining the indication for the corrective surgery was also investigated. We studied 235 patients who underwent primary treatment for DDH during the past decade (between October, 1988 and September, 1998). Of the 235 patients, we studied 23 patients (23 cases; all unilateral cases) who showed residual subluxation and whose MR images were taken when they were around 3 years old, and during a follow-up period was available. Corrective surgery is performed in 11 patients, whereas the remaining 12 patients were conservatively observed the course of the residual subluxation. We investigated the existence of high signal intensity area (hereinafter referred to as HSIA) within the weight-bearing acetabular cartilage on T2-weighted MR coronal section images. Furthermore, conservatively observed patients were divided into two groups according to T2-weighted MR images. Based on simple X-ray images with time in both groups, the acetabular angle and the CE angle were measured. As results, many patients with residual subluxation showed localized HSIA in the weight-bearing acetabular cartilage on T2-weighted MR images. Although all patients who underwent corrective surgery showed HSIA, HSIA disappeared or decreased after the surgery. Of patients who were conservatively observed the course of the residual subluxation, patients showed HSIA on MR image had poor

  20. CLINICAL AND RADIOLOGICAL EVALUATION ON DEVELOPMENTAL HIP DYSPLASIA AFTER SALTER AND OMBRÉDANNE PROCEDURE

    da Rocha, Válney Luiz; Thomé, André Luiz Coelho; da Silva Castro, Daniel Labres; de Oliveira, Leandro Zica; de Moraes, Frederico Barra

    2015-01-01

    Objective: To evaluate the clinical and radiological medium-term results from surgical treatment of developmental hip dysplasia through Salter innominate bone osteotomy and Ombrédanne femoral shortening. Methods: Fourteen patients were evaluated, with surgical treatment on 18 hips (seven right-side hips and eleven left-side hips) using the proposal technique, performed between 1998 and 2008. The Dutoit and Severin criteria were used respectively for clinical and radiographic evaluations. Results: The average preoperative index for the seven right-side hips was 43.3° (40° to 50°), and this was corrected through surgery to an average of 31.57° (24° to 42°). The average preoperative index for the eleven left-side hips was 42.1° (36° to 56°), and this was corrected through surgery to an average of 30.36° (20° to 44°). There was a statistically significant difference between the preoperative and postoperative acetabular indexes, with P > 0.05. The clinical evaluation showed that there were seven excellent hips (38.9%), eight good ones (44.4%), three fair hips (16.7%) and no poor ones (0%). By grouping the hips rated good and excellent as satisfactory and those rated poor and fair as unsatisfactory, 83.3% of the results were seen to be favorable. There were no statistically significant correlations between occurrences of complications and patient age at the time of surgery or between complications and the preoperative acetabular index (p > 0.05). The complications observed consisted of one case each of subluxation, osteonecrosis and osteonecrosis together with subluxation. Conclusion: The combined procedure of Salter and Ombrédanne is a viable option for treating developmental hip dysplasia after patients have started to walk. PMID:27027068

  1. Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients

    Follow-up of pseudotumors observed with metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) following metal-on-metal total hip arthroplasty (MoMTHA) depends on how severe these pseudotumors are graded. Several pseudotumor grading systems for MARS-MRI have emerged but little is known of their validity. We studied the intra- and interobserver reliability of three different pseudotumor grading systems in a single cohort of MoMTHA. Two experienced musculoskeletal radiologists independently used three different pseudotumor grading systems for classifying MARS-MRI results of the same cohort of 42 MoMTHA patients (49 hips, mean follow-up 5.2 years). Intraobserver and interobserver reliability for each grading system was measured using Cohen's kappa (κ). Variance in pseudotumor severity grading between systems was analyzed. Intraobserver reliability on grading pseudotumor severity with the Anderson, Matthies, and Hauptfleisch grading system scored 0.47, 0.10, and 0.35 (observer 1), and 0.75, 0.38, and 0.42 (observer 2), respectively. Interobserver reliability scores for pseudotumor severity were 0.58, 0.23, and 0.34, respectively. Intraobserver reliability for grading pseudotumor severity on MARS-MRI ranged from poor to good, dependent on observer and grading system used. Interobserver reliability scored best with the Anderson system. A more succinct pseudotumor severity grading system is needed for clinical use. (orig.)

  2. Comparison of different pseudotumor grading systems in a single cohort of metal-on-metal hip arthroplasty patients

    Weegen, W. van der; Wullems, J.A.; Das, H.P. [St. Anna Hospital, Department of Orthopaedic Surgery, Geldrop (Netherlands); Brakel, K.; Horn, R.J. [St. Anna Hospital, Department of Radiology, Geldrop (Netherlands); Pilot, P. [Reinier de Graaf Gasthuis, Department of Orthopaedic Surgery, Delft (Netherlands); Nelissen, R.G. [Leids Universitair Medisch Centrum, Department of Orthopaedic Surgery, Leiden (Netherlands)

    2014-02-15

    Follow-up of pseudotumors observed with metal-artefact reducing sequence (MARS)-magnetic resonance imaging (MRI) following metal-on-metal total hip arthroplasty (MoMTHA) depends on how severe these pseudotumors are graded. Several pseudotumor grading systems for MARS-MRI have emerged but little is known of their validity. We studied the intra- and interobserver reliability of three different pseudotumor grading systems in a single cohort of MoMTHA. Two experienced musculoskeletal radiologists independently used three different pseudotumor grading systems for classifying MARS-MRI results of the same cohort of 42 MoMTHA patients (49 hips, mean follow-up 5.2 years). Intraobserver and interobserver reliability for each grading system was measured using Cohen's kappa (κ). Variance in pseudotumor severity grading between systems was analyzed. Intraobserver reliability on grading pseudotumor severity with the Anderson, Matthies, and Hauptfleisch grading system scored 0.47, 0.10, and 0.35 (observer 1), and 0.75, 0.38, and 0.42 (observer 2), respectively. Interobserver reliability scores for pseudotumor severity were 0.58, 0.23, and 0.34, respectively. Intraobserver reliability for grading pseudotumor severity on MARS-MRI ranged from poor to good, dependent on observer and grading system used. Interobserver reliability scored best with the Anderson system. A more succinct pseudotumor severity grading system is needed for clinical use. (orig.)

  3. Radiological findings for hip dysplasia at skeletal maturity. Validation of digital and manual measurement techniques

    Engesaeter, Ingvild Oevsteboe [University of Bergen, Department of Surgical Sciences, Bergen (Norway); Haukeland University Hospital, Department of Orthopaedic Surgery, Bergen (Norway); Haukeland University Hospital, Department of Radiology, Bergen (Norway); Haukeland University Hospital, The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Bergen (Norway); Laborie, Lene Bjerke; Rosendahl, Karen [University of Bergen, Department of Surgical Sciences, Bergen (Norway); Haukeland University Hospital, Department of Radiology, Bergen (Norway); Lehmann, Trude Gundersen; Fevang, Jonas; Engesaeter, Lars Birger [University of Bergen, Department of Surgical Sciences, Bergen (Norway); Haukeland University Hospital, Department of Orthopaedic Surgery, Bergen (Norway); Sera, Francesco [University College London Institute of Child Health, Medical Research Council Centre of Epidemiology for Child Health, London (United Kingdom); Pedersen, Douglas; Morcuende, Jose [University of Iowa Hospital and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, IA (United States); Lie, Stein Atle [Uni Health, Uni Research, Bergen (Norway)

    2012-07-15

    To report on intra-observer, inter-observer, and inter-method reliability and agreement for radiological measurements used in the diagnosis of hip dysplasia at skeletal maturity, as obtained by a manual and a digital measurement technique. Pelvic radiographs from 95 participants (56 females) in a follow-up hip study of 18- to 19-year-old patients were included. Eleven radiological measurements relevant for hip dysplasia (Sharp's, Wiberg's, and Ogata's angles; acetabular roof angle of Toennis; articulo-trochanteric distance; acetabular depth-width ratio; femoral head extrusion index; maximum teardrop width; and the joint space width in three different locations) were validated. Three observers measured the radiographs using both a digital measurement program and manually in AgfaWeb1000. Inter-method and inter- and intra-observer agreement were analyzed using the mean differences between the readings/readers, establishing the 95% limits of agreement. We also calculated the minimum detectable change and the intra-class correlation coefficient. Large variations among different radiological measurements were demonstrated. However, the variation was not related to the use of either the manual or digital measurement technique. For measurements with greater absolute values (Sharp's angle, femoral head extrusion index, and acetabular depth-width ratio) the inter- and intra-observer and inter-method agreements were better as compared to measurements with lower absolute values (acetabular roof angle, teardrop and joint space width). The inter- and intra-observer variation differs notably across different radiological measurements relevant for hip dysplasia at skeletal maturity, a fact that should be taken into account in clinical practice. The agreement between the manual and digital methods is good. (orig.)

  4. [Cauda equina hemisyndrome after intradural anesthesia with bupivacaine for hip surgery].

    López-Soriano, F; Lajarín, B; Verdú, J M; Rivas, F; López-Robles, J

    2002-11-01

    A 68-year-old man underwent hip surgery under subarachnoid anesthesia with bupivacaine and fentanyl to replace an acetabular component. Two days after surgery the patient developed unilateral cauda equina syndrome, affecting five nerve roots (L4 to S3), with no sphincter involvement. Two and a half years later, the lesion had become permanent. We discuss the possible origin of the condition, suggesting differential diagnoses such as mechanical problems (position-mobilization) and anesthetic toxicity. PMID:12516495

  5. Radiological findings for hip dysplasia at skeletal maturity. Validation of digital and manual measurement techniques

    To report on intra-observer, inter-observer, and inter-method reliability and agreement for radiological measurements used in the diagnosis of hip dysplasia at skeletal maturity, as obtained by a manual and a digital measurement technique. Pelvic radiographs from 95 participants (56 females) in a follow-up hip study of 18- to 19-year-old patients were included. Eleven radiological measurements relevant for hip dysplasia (Sharp's, Wiberg's, and Ogata's angles; acetabular roof angle of Toennis; articulo-trochanteric distance; acetabular depth-width ratio; femoral head extrusion index; maximum teardrop width; and the joint space width in three different locations) were validated. Three observers measured the radiographs using both a digital measurement program and manually in AgfaWeb1000. Inter-method and inter- and intra-observer agreement were analyzed using the mean differences between the readings/readers, establishing the 95% limits of agreement. We also calculated the minimum detectable change and the intra-class correlation coefficient. Large variations among different radiological measurements were demonstrated. However, the variation was not related to the use of either the manual or digital measurement technique. For measurements with greater absolute values (Sharp's angle, femoral head extrusion index, and acetabular depth-width ratio) the inter- and intra-observer and inter-method agreements were better as compared to measurements with lower absolute values (acetabular roof angle, teardrop and joint space width). The inter- and intra-observer variation differs notably across different radiological measurements relevant for hip dysplasia at skeletal maturity, a fact that should be taken into account in clinical practice. The agreement between the manual and digital methods is good. (orig.)

  6. Alumina Inlay Failure in Cemented Polyethylene-backed Total Hip Arthroplasty

    Iwakiri, Kentaro; Iwaki, Hiroyoshi; Minoda, Yukihide; Ohashi, Hirotsugu; Takaoka, Kunio

    2008-01-01

    Alumina-on-alumina bearings for THA have markedly improved in mechanical properties through advances in technology; however, alumina fracture is still a concern. We retrospectively reviewed 77 patients (82 hips) with cemented alumina-on-alumina THAs to identify factors relating to alumina failure. The mean age of the patients at surgery was 63 years. The prostheses had a cemented polyethylene-backed acetabular component with an alumina inlay and a 28-mm alumina head. Revision surgery was perf...

  7. Understanding total hip replacement recovery towards the design of a context-aware system

    Jimenez Garcia, Juan

    2011-01-01

    Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery. Curren

  8. Bernese periacetabular osteotomy for hip dysplasia: Surgical technique and indications.

    Kamath, Atul F

    2016-05-18

    For young, active patients with healthy hip cartilage, pelvic osteotomy is a surgical option in to address hip pain and to improve mechanical loading conditions related to dysplasia. Hip dysplasia may lead to arthrosis at an early age due to poor coverage of the femoral head and abnormal loading of the joint articulation. In patients with symptomatic dysplasia and closed triradiate cartilage (generally over age 10), including adolescents and young adults (generally up to around age 40), the Bernese periacetabular osteotomy (PAO) is a durable technique for addressing underlying structural deformity. The PAO involves a modified Smith-Petersen approach. Advantages of the Bernese osteotomy include preservation of the weight-bearing posterior column of the hemi-pelvis, preservation of the acetabular blood supply, maintenance of the hip abductor musculature, and the ability to effect powerful deformity correction about an ideal center of rotation. There is an increasing body of evidence that preservation of the native hip can be improved through pelvic osteotomy. In contrast to hip osteotomy and joint preservation, the role of total hip arthroplasty in young, active patients with correctable hip deformity remains controversial. Moreover, the durability of hip replacement in young patients is inherently limited. Pelvic osteotomy should be considered the preferred method to address correctable structural deformity of the hip in the young, active patient with developmental dysplasia. The Bernese PAO is technically demanding, yet offers reproducible results with good long-term survivorship in carefully selected patients with preserved cartilage and the ability to meet the demands of rehabilitation. PMID:27190755

  9. 'Hip' pain.

    Zacher, Josef; Gursche, Angelika

    2003-02-01

    'Hip' pain is usually located in the groin, upper thigh or buttock and is a common complaint. Slipped capital femoral epiphysis, avascular femoral head necrosis and apophyseal avulsion are the most common diagnoses in childhood and adolescents. Strains and fractures are common in sport-active adults. Osteoarthritis occurs in middle-aged and older adults. Trauma may result in femoral head fracture or typical muscle and tendon sprains and bursitis. Septic or inflammatory arthritis can occur at every age. Septic arthritis, fractures and acute epiphyseal slipping are real emergency cases. Congenital dysplasia of the hip joint may lead to labral tears and early osteoarthritis. The most important hip problems in children, adolescents, adult and older people are discussed; these problems originate from intra-articular disorders and the surrounding extra-articular soft tissues. Medical history, clinical examination and additional tests, including imaging, will be demonstrated. Principles of treatment are given for specific disorders. PMID:12659822

  10. Taper Hip Prosthesis

    Full Text Available ... patient on the table in a very predictable fashion. In this case, we've used a device, ... Zimmer trabecular metal acetabular component in a modular fashion today. My favorite component. And with a nice ...

  11. Ultrasonography of the painful hip in childhood

    S.G.F. Robben (Simon)

    1999-01-01

    textabstractThere are many diseases in childhood that affect the hip joint. Some diseases are systemic in origin and initially may present themselves as hip disorders, such as rheumatoid arthritis. other diseases are localized specifically in the hip joint, such as transient synovitis and Perthes' d

  12. Management of developmental dysplasia of the hip in less than 24 months old children

    Mehmet Bulut

    2013-01-01

    Full Text Available Background: There is no consensus on the treatment of developmental dysplasia of the hip in children less than 24 months of age. The aim of this study was to present the results of open reduction and concomitant primary soft-tissue intervention in patients with developmental dysplasia of the hip in children less than 24 months of age. Materials and Methods: Sixty hips of 50 patients (4 male, 46 female with mean age of 14.62 ± 5.88 (range 5-24 months months with a mean followup of 40.00 ± 6.22 (range 24-58 months months were included. Twenty five right and 35 left hips (10 bilaterally involved were operated. Open reduction was performed using the medial approach in patients aged < 20 months (with Tönnis type II-III and IV hip dysplasias and for those aged 20-24 months with Tönnis type II and III hip dysplasias ( n = 47. However for 13 patients aged 20-24 months with Tönnis type IV hip dysplasias, anterior bikini incision was used. Results: Mean acetabular index was 41.03 ± 3.78° (range 34°-50° in the preoperative period and 22.98 ± 3.01° (range 15°-32° at the final visits. Mean center-edge angle at the final visits was 22.85 ± 3.35° (18°-32°. Based on Severin radiological classification, 29 (48.3% were type I (very good, 25 (41.7% were type II (good and 6 (10% were type III (fair hips. According to the McKay clinical classification, postoperatively the hips were evaluated as excellent ( n = 42; 70%, good ( n = 14; 23.3% and fair ( n = 4; 6.7%. Reduction of all hip dislocations was achieved. Additional pelvic osteotomies were performed in 14 (23.3% hips for continued acetabular dysplasia and recurrent subluxation. (Salter [ n = 12]/Pemberton [ n = 2] osteotomy was performed. Avascular necrosis (AVN developed in 7 (11.7% hips. Conclusion: In DDH only soft-tissue procedures are not enough, because of the high rate of the secondary surgery and AVN for all cases aged less than 24 months. Bone procedures may be necessary in the walking

  13. Three-dimensional model of cementless acetabular cup migration

    Jíra, J.; Jiroušek, Ondřej; Jírová, Jitka; Micka, Michal

    Lisbon : CivilComp Press, 2004 - (Tooping, B.; Mota Soares, C.), s. 699 ISBN 0-948749-93-8. [The Seventh International Conference on Computational Structures Technology. Lisabon (PT), 07.09.2004-09.09.2004] Institutional research plan: CEZ:AV0Z2071913 Keywords : loosening and migration of cementless acetabular cup * pelvis * FE model Subject RIV: FI - Traumatology, Orthopedics

  14. Evaluation of POSSUM scoring system in the treatment of osteoporotic fracture of the hip in elder patients

    WANG Tie-jun; ZHANG Bo-hao; GU Gui-shan

    2008-01-01

    To evaluate the applicability of the modified physiological and operative severity score for enumeration of mortality and morbidity(POSSUM)scoring system in predicting mortality in the patients undergoing hip joint arthroplasty.Methods:A total of 295 patients with hip fractures were analyzed using the modified POSSUM surgical scoring system. The mean ages of the patients were 66.59 years in the complicative group,62.28 years in noncomplicative group,77.89 years in the death group and 63.25 years in the living group,respectively. The comparisons between the observed and predicted morbidity,between the observed and predicted mortality were made within 30 days after operation.Results:The average physiological scores and operative severity scores was 18.96±4.83 and 13.47±2.01 in compticative group, while 15.65±3.66 and 11.74±2.26 in noncomplicative group(P<0.05).The average physiological scores and operative severity scores was 25.56±3.78 and 14.22±0.67 in death group,while 16.46±4.09 and 12.25 ±2.33 in living group (P<0.05).Though POSSUM scoring system over-predicted the overall risk of death,its estimate was very close in the high risk groups(>10%). There was perfect consistence between the observed and the predicted morbidity as calculated by published predictor equation for morbidity,and consistence for mortality in the high risk band.Conclusions:Modified POSSUM scoring system may be used to predict the morbidity in patients with hip fracture.Furthermore,POSSUM scoring system overpredicts the overall risk of death, but its estimate iS close to the actual data in the high risk band(>10%).

  15. Cementless Hip Arthroplasty in Southern Iran, Midterm Outcome and Comparison of Two Designs

    Gholam Hossein Shahcheraghi

    2015-09-01

    Full Text Available Background: Cementless hip prosthesis was designed to provide biologic fixation, without the use of cement. The second generation components have shown more reliable bone ingrowths and survival rates. We are reporting a midterm result of two designs of cementless prosthesis in a unique culture with different social habits and expectations. Methods: 52 primary cementless total hip arthroplasty in 42 patients with the mean age of 48.8 years were retrospectively studied. Two groups of prosthesis had been implanted: Harris-Galante II (HGII in 15 and Versys-Trilogy (V-T in 37 hips, both from Zimmer company. The patients were assessed clinically, radiographically and with Harris hip score, SF36, WOMAC, and MACTAR questionnaires, with 65 months (26-136 mean follow-up. Results: All the V-T prostheses had survived well. Eight of HG II were revised by the last follow-up in 19-102 months. All had undergone acetabular revision and 2 combined with femoral revision. Broken tines of HGII cups were seen in 4 radiographs. The 65 months overall survival was 96.2% for femoral and 84.6% for acetabular components. 90% had good or excellent Harris hip scores. The functional scores were poorer in the HG II group. Pain relief and improved walking were the two main patients’ expectations fulfilled in 97.6% and 92.8%, respectively. Conclusions: The outcome of cementless total hip arthroplasty (THA is satisfactory and comparable with the literature based on the results of function and survival of this small comparative group. The use of HGII acetabular component should be abandoned.

  16. Hip and pelvis diseases on lumbar AP radiographs including both hip joints

    To determine the frequency of disease, and to evaluate the methods used for lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1215 patients, taken using 14x17 inch film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesion, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesion in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 or the 20 hospitals which responded, 14x17film was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis

  17. Hip and pelvis diseases on lumbar AP radiographs including both hip joints

    Lim, Hyun Soo; Juhng, Seon Kwan; Kim, Eun A; Kim, Jeong Ho; Song, Ha Heon; Shim, Dae Moo [Wonkwang University School of Medicine, Iksan (Korea, Republic of)

    2002-12-01

    To determine the frequency of disease, and to evaluate the methods used for lumbar spine radiography in Korea. Sixty university and training hospitals were randomly selected and asked to describe the projections, film size and radiographic techniques employed for routine radiography in patients with suspected disease of the lumbar spine. Plain radiographs of 1215 patients, taken using 14x17 inch film and depicting both hip joints and the lumbar region, were analysed between March 1999 and February 2000. In 15 patients (1.2%), the radiographs revealed hip or pelvic lesion, confirmed as follows: avascular necrosis of the femoral head (n=11, with bilateral lesion in four cases); sustained ankylosing spondylitis (n=2); acetabular dysplasia (n=1); and insufficiency fracture of the pubic rami secondary to osteoporosis (n=1). In 11 or the 20 hospitals which responded, 14{sup x}17{sup f}ilm was being used for lumbar radiography, while in the other nine, film size was smaller. Plain radiography of the lumbar spine including both hip joints, may be a useful way to simultaneously evaluate lesions not only of the lumbar spine but also of the hip and/or pelvis.

  18. Primary abductor hip contracture as diagnostic, prognostic and therapeutic problem in child hip pathology

    Pajić Miloš

    2007-01-01

    Full Text Available Coxa obliqua represents a special functional entity in the pathology of the child hip. Authors have confirmed the results of S.L. Weissman and B. Strinovic which claimed that the abductor contracture of the hip was a primary congenital condition that developed as a result of intrauterine malposition, leading later to the contralateral adductor contracture. Critical period for the development of complications was between 6 and 8 month after birth, adductor contracture might keep persisting together with the development of acetabular dysplasia, and later on with ipsilateral subluxation. This malformation has usually been diagnosed within 3 and 6 months of age. It could be connected with some other signs of malposition, such as plagiocephaly, torticollis or infantile thoracic C scoliosis. For the diagnosis of coxa obliqua, the examination of hips in the prone position was very important and the ultrasonic and radiological examinations were crucial. The applied treatment used to be exclusively physical rehabilitation. Wide diapering has been contraindicated. In this study, we included 2,500 newborns, 1,300 boys and 1,200 girls (5,000 hips. In 22 cases of coxa obliqua (10‰, the excellent results were obtained in 96% of cases. In two unsuccessfully treated cases, a contralateral dysplasia developed, and in one untreated, subluxation. The authors are advocating a systematic and early detection and treatment of the primary coxa obliqua. .

  19. Hip Revision

    Full Text Available ... re going to initially look at Scott's preoperative x-rays and just kind of describe the situation that ... up to that time. Here's Scott's initial preoperative x-ray, where we see a hybrid hip arthroplasty with ...

  20. Space orientation of total hip prosthesis

    A method for in vivo determination of orientation and relation in space of components of total hip prosthesis is described. The method allows for determination of the orientation of the prosthetic components in well defined anatomic planes of the body. Furthermore the range of free motion from neutral position to the point of contact between the edge of the acetabular opening and the neck of the femoral component can be determined in various directions. To assess the accuracy of the calculations a phantom prosthesis was studied in nine different positions and the measurements of the space oriented parameters according to the present method correlated to measurements of the same parameters according to Selvik's stereophotogrammetric method. Good correlation ws found. The role of prosthetic malpositioning and component interaction evaluated with the present method in the development of prosthetic loosening and displacement is discussed. (orig.)

  1. Analysis of migration of press-fit porous-coated acetabular components with medial lucencies using Ein-Bild-Roentegen-Analyse.

    Sadeghi, Cameron; Gibson, Anthony G; Ries, Michael D

    2012-08-01

    A total of 136 patients who underwent total hip arthroplasty (154 hips) with press-fit acetabular components were evaluated for the presence of medial radiographic lucencies. Thirty patients (22.1%) demonstrated radiolucencies greater than 1 mm in zone 2 on initial postoperative films. Ein-Bild-Roentegen-Analyse (EBRA) was used to evaluate component migration over a 5-year follow-up period. Migration, measured by EBRA, was not observed during the first 6 months when the radiolucencies were noted to disappear. After 2 years, the mean total migration was 0.8 mm, and at 5 years, it was 1.6 mm. Our results indicate that disappearance of a medial radiolucency seen on early postoperative radiographs is not associated with component migration, which supports the concept that the medial radiolucency fills in with bone or represents bony remodeling around a stable implant. PMID:22177796

  2. HIP 3678: a hierarchical triple stellar system in the centre of the planetary nebula NGC 246

    Adam, C

    2014-01-01

    We report the detection of a new low-mass stellar companion to the white dwarf HIP 3678 A, the central star of the planetary nebula NGC 246. The newly found companion is located about 1 arcsec (at projected separation of about 500 au) north-east of HIP 3678 A, and shares a common proper motion with the white dwarf and its known comoving companion HIP 3678 B. The hypothesis that the newly detected companion is a non-moving background object can be rejected on a significance level of more than 8 $\\sigma$, by combining astrometric measurements from the literature with follow-up astrometry, obtained with Wild Field Planetary Camera 2/\\textit{Hubble Space Telescope} and NACO/Very Large Telescope. From our deep NACO imaging data, we can rule out additional stellar companions of the white dwarf with projected separations between 130 up to 5500 au. In the deepest high-contrast NACO observation, we achieve a detection limit in the \\textit{Ks} band of about 20 mag, which allows the detection of brown dwarf companions w...

  3. Novel anthropomorphic hip phantom corrects systemic interscanner differences in proximal femoral vBMD

    Quantitative computed tomography (QCT) is increasingly used in osteoporosis studies to assess volumetric bone mineral density (vBMD), bone quality and strength. However, QCT is confronted by technical issues in the clinical research setting, such as potentially confounding effects of body size on vBMD measurements and lack of standard approaches to scanner cross-calibration, which affects measurements of vBMD in multicenter settings. In this study, we addressed systematic inter-scanner differences and subject-dependent body size errors using a novel anthropomorphic hip phantom, containing a calibration hip to estimate correction equations, and a contralateral test hip to assess the quality of the correction. We scanned this phantom on four different scanners and we applied phantom-derived corrections to in vivo images of 16 postmenopausal women scanned on two scanners. From the phantom study, we found that vBMD decreased with increasing phantom size in three of four scanners and that inter-scanner variations increased with increasing phantom size. In the in vivo study, we observed that inter-scanner corrections reduced systematic inter-scanner mean vBMD differences but that the inter-scanner precision error was still larger than expected from known intra-scanner precision measurements. In conclusion, inter-scanner corrections and body size influence should be considered when measuring vBMD from QCT images. (paper)

  4. Hip dysplasia and congenital hip dislocation

    Lingg, G.; Nebel, G.; von Torklus, D.

    1981-11-01

    In human genetics and orthopedics quite different answers have been given to the question of hereditary transmission and frequency of hip dysplasia in families of children with congenital hip dislocation. We therefore have made roentgenometric measurements of 110 parents of children with congenital hip dislocation. In 25% we found abnormal flat acetabulae, whereas 12% had pathologic deep hips. This may propose a new concept of morphology of congenital hip dysplasia.

  5. MR Imaging in Postreduction Assessment of Developmental Dysplasia of the Hip: Goals and Obstacles.

    Rosenbaum, Daniel G; Servaes, Sabah; Bogner, Eric A; Jaramillo, Diego; Mintz, Douglas N

    2016-01-01

    Developmental dysplasia of the hip is a spectrum disorder of hip development that ranges in severity from abnormal acetabular morphology to complete hip dislocation. While treatment with a Pavlik harness is highly effective in infants younger than 6 months, older infants and children and those with orthotic failure often warrant surgical reduction and placement of a spica cast, which limits subsequent imaging evaluation. Magnetic resonance (MR) imaging has been described in the evaluation of the adequacy of hip reduction for more than 2 decades, but the practice is still not widespread and is performed routinely at relatively few centers. MR imaging is a robust tool for outcome assessment after hip reduction and placement of a spica cast, facilitating multiplanar confirmation of concentric reduction independent of an ossific nucleus or orthopedic hardware. Excellent image contrast of soft tissues allows identification of obstacles to concentric reduction, which may be extra-articular or intra-articular. Extra-articular obstacles include tightening of the adductor muscles and tightening of the iliopsoas tendon with constriction of the joint capsule. Intra-articular obstacles include limbus formation, labral inversion, an enlarged pulvinar, and hypertrophy of the ligamentum teres and/or the transverse acetabular ligament. Intravenous contrast material administration may demonstrate altered epiphyseal blood flow and help identify patients at risk for early ischemia. Imaging technique and image interpretation can be optimized to facilitate the performance of postreduction MR imaging studies where they may be of benefit. (©)RSNA, 2016. PMID:27035836

  6. Late-presenting developmental dysplasia of the hip in Jordanian males

    Samarah, Omar Q.; Hadidi, Fadi A. Al; Hamdan, Mohammad Q.; Hantouly, Ashraf T.

    2016-01-01

    Objectives: To describe the pattern of developmental dysplasia of the hip (DDH) in late presenting Jordanian male patients and identify the risk factors and associated findings. Methods: This is a retrospective study of 1145 male patients who attended the Pediatric Orthopedic Clinic for a DDH check up. This study was carried out in the Orthopedic Section, Special Surgery Department, Faculty of Medicine, The University of Jordan, Amman, Jordan between March 2011 and October 2014. Data was collected from medical records, and x-ray measurements were evaluated. Results: Of the 1145 male patients, 43 (3.75%) with 70 involved hips were diagnosed with late- presenting DDH. Being a first-born baby resulted in 41.9% increased risk for DDH. Cesarian delivery was significantly associated with an increased risk of hip dislocation (p=0.004) while normal delivery was significantly associated with acetabular dysplasia (p=0.004). No predictable risk factors were found in 44.2% patients with DDH. Bilateral cases were more common than unilateral cases: (26 [60.5%] versus 17 [39.5%]). Limited abduction was a constant finding in all dislocated hips (pcongenital muscular torticollis were not observed. Conclusion: Cesarian section is a significant risk for dislocated hips while normal delivery is significantly associated with acetabular dysplasia. Bilateral DDH is more common than the unilateral. Club foot and torticollis were not observed in this series. PMID:26837397

  7. [Congenital hip dysplasia, screening and therapy].

    Kolb, A; Windhager, R; Chiari, C

    2015-11-01

    Congenital hip dysplasia and hip dislocation are relatively common pathological conditions of the musculoskeletal system in infants. An early and certain diagnosis can now be achieved by sonographic hip screening within the framework of screening examination programs. This early diagnostic procedure in infants is essential particularly for a conservative treatment strategy. Therefore, apart from possessing in-depth knowledge, training of the examiner in specialist courses is of central importance. This article presents an overview of the entity of congenital hip dysplasia and hip dislocation, the diagnostics and treatment with special emphasis on recent developments. PMID:26489825

  8. Tantalum as a buffer layer in diamond-like carbon coated artificial hip joints.

    Kiuru, Mirjami; Alakoski, Esa; Tiainen, Veli-Matti; Lappalainen, Reijo; Anttila, Asko

    2003-07-15

    The acid resistance of tantalum coated and uncoated human hip joint prostheses was studied with commercial CrCoMo acetabular cups. The samples were exposed to 10% HCl solution and the quantities of dissolved Cr, Co, and Mo were measured with proton-induced X-ray emission (PIXE). The absolute quantities were obtained with the use of Cr and Se solution standards. Tantalum coatings (thicknesses 4-6 microm) were prepared in vacuum with magnetron sputtering. Tantalum coating decreased the corrosion rate by a factor of 10(6). As a spinoff from recent wear tests on artificial hip joints it was shown that tantalum has excellent mechanical properties as an intermediate layer of diamond-like carbon (DLC) coatings. When tantalum was tested together with DLC on three metal-on-metal hip joint pairs in a hip simulator, no observable defects occurred during 15 million walking cycles with a periodic 50-300-kg load (Paul curve). PMID:12808604

  9. Hip replacement

    Patients with problems following implantation of cemented total hip prostheses must be clinically examined. This examination is followed by a series of diagnostic imaging procedures. These include X-ray diagnosis, 3-phase 99mTc-MDP bone scans, scientigraphy for inflammation, and arthrography, performed singly or as sequential studies. X-ray findings and scientigraphic patterns arousing or confirming a suspicion of aseptic (mechanical) or septic (infectious) loosening of the prosthesis are evaluated and discussed. (orig.)

  10. Difference in the acetabular cup orientation in standing and supine radiographs.

    Khan, Munir; Beckingsale, Tom; Marsh, Martin; Holland, Jim

    2016-09-01

    Acetabular orientation changes with that of the pelvis during lying and standing. This study was designed to measure these changes. We assessed 17 BHR replacements using EBRA software. The mean acetabular anteversion was more (p = 0.02) on erect than supine radiographs. Linear regression analysis showed that anteversion and inclination increased in some while decreased in others, and Bland and Altman analysis showed wide limits of agreement. The changes in acetabular orientation are thus subject to significant variations between the patients. We suggest studying the factors affecting acetabular orientation in standing to help reduce joint reaction forces and improve outcomes. PMID:27408490

  11. Application of uncemented Zweymüller hip prosthesis in adult patients with hip osteoarthritis secondary to developmental dysplasia

    XU Yong-sheng; WANG Yan; LU Long; WEI Bao-gang

    2012-01-01

    Background Developmental dysplasia encompasses a wide spectrum of hip pathology ranging from a shallow acetabulum to a completely dislocated ‘high-riding' hip.It is a common cause of secondary osteoarthritis in young adults and is the underlying diagnosis in up to 48% of patients requiring total hip arthroplasty (THA) for coxarthrosis.The aim of this study was to evaluate efficiency and safety of THA using Zweymüller hip implant in the treatment of severe osteoarthritis secondary to developmental dysplasia of the hip (DDH) in adults.Methods From January 2000 to February 2008,35 patients (40 hips) with developmental dysplasia of the hip were included.Five were male and 30 were female,with ages ranging from 26 to 65 years and an average age of 45 years.According to Hartofilakidis classification,there were type Ⅰ in 5 hips,type Ⅱ in 20 hips,type Ⅲ in 15 hips.All the patients were performed the THA using the Zweymüller hip implant.The preoperative average Harris score was 44.The bilateral arthroplasty was performed in 5 patients and the unilateral arthroplasty in 30 patients.The patients mainly suffered from pain and claudication.Clinical and radiological results were analyzed.The Harris score was used for outcome measurement.Results Thirty five patients (40 hips) were followed and the mean follow-up period was 46 months (ranged from 24 months to 96 months).The latest follow-up average Harris score was 88.9 (97.1% of good rate).All the patients were pain-free and there was no sign of infection,aseptic loosening and subsidence.Conclusions In summary,THA using Zweymüller hip implant is a good treatment method for severe osteoarthritis secondary to DDH in adults.The key techniques for the total hip replacement are as follows:good preoperative plan,firmly placing the acetabular component in the true acetabulum,proper preparation of proximal femur,suitable femoral component choosing and improving the techniques of the bone graft.

  12. Acetabular prosthesis: Proff of migration with ruler and pencil?

    Conventional X-ray films were made with varying degrees of tilt of a pelvic phantom containing an acetabular prosthesis. The position of the prosthesis was then reconstructed graphically. The measurement errors were calculated and an estimate was made for the tilt. There is a linear correlation between the measurement error and the tilt of the prosthesis. Therefore a tilt dependent maximum error can be calculated. This error is very small for small degrees of tilt, so that acetabular migration can in this instance be evaluated with greater confidence than with other graphical methods. The error also correlates with the determination of the selected region of the acetabulum, but not with the position of the central focus spot or image magnification. (orig.)

  13. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion

  14. The fate of the hip in spondylo-epi-metaphyseal dysplasia: clinical and radiological evaluation of adults with SEMD Handigodu type

    This study was undertaken to document the fate of the hip with reference to its structure and function in patients with spondylo-epi-metaphyseal dysplasia tarda Handigodu type (SEMDHG). Radiographs of 271 adult patients with SEMDHG were studied to identify the pattern of long-term sequelae in the hips. Several measurements of the proximal femur and acetabulum were made to quantify morphological alterations in the hip. Fifty-four adult patients were examined and administered a questionnaire to evaluate the extent of disability attributable to the hips. Three patterns of changes in the hips were noted: 35% had acetabular protrusio, 33% had subluxation of the hip, and 32% had no protrusio or subluxation. Distinctly different anthropometric measurements and dimensional alterations around the hip were noted in these three patterns. Patients with protrusio were relatively tall while those with subluxation were the shortest. All the patients had developed degenerative arthritis of the hips by the fourth decade of life irrespective of the pattern of hip involvement. The reduction in the range of hip motion and fixed deformities were most severe in patients with protrusio. All the patients had significant disability and very low functional hip scores. Degenerative arthritis of the hip develops in the majority of patients with SEMDHG; the symptoms are severe enough to warrant reconstructive surgery by the fourth decade of life. Protrusio or subluxation develops in a third of the patients each; both these complications will influence the surgical approach if total hip arthroplasty is planned. (orig.)

  15. Favourable results of a new intraoperative and postoperative filtered autologous blood re-transfusion system in total hip arthroplasty : A randomised controlled trial

    Horstmann, Wieger G.; Swierstra, Martzen J.; Ohanis, David; Rolink, Rob; Kollen, Boudewijn J.; Verheyen, Cees C. P. M.

    2014-01-01

    A new intraoperative filtered salvaged blood re-transfusion system has been developed for primary total hip arthroplasty (THA) that filters and re-transfuses the blood that is lost during THA. This system is intended to increase postoperative haemoglobin (Hb) levels, reduce perioperative net blood l

  16. Contact Stress Analysis of Acetabular Component and Pelvic Bone

    Vyčichl, Jan; Jiroušek, Ondřej; Jírová, Jitka

    Wroclaw : Oficyna Wydawnicza Politechniki Wroclawskiej, 2006 - (Grygier, D.), s. 73-74 ISSN 1732-0240. [ Students ' Scientific Conference of Biomedical Engineeting /2/. Szklarska Poreba (PL), 20.04.2006-23.04.2006] R&D Projects: GA AV ČR(CZ) IAA200710504 Institutional research plan: CEZ:AV0Z20710524 Keywords : pelvic bone * acetabular component * stress analysis * finite element method Subject RIV: EI - Biotechnology ; Bionics

  17. Bursitis of the Hip

    MENU Return to Web version Bursitis of the Hip Overview What is bursitis? Bursitis (say: “burse-eye- ... bursitis is swelling affecting the bursae of the hip. Bursitis does not only happen in the hip. ...

  18. Hip fracture surgery

    ... repair; Femoral neck fracture repair; Trochanteric fracture repair; Hip pinning surgery; Osteoarthritis-hip ... top of the bone) you may have a hip pinning procedure. During this surgery: You lie on ...

  19. Hip fracture - discharge

    ... 2012:chap 55. Read More Broken bone Hip fracture surgery Hip pain Leg MRI scan Osteoporosis - overview Patient Instructions Getting your home ready - knee or hip surgery Osteomyelitis - discharge Update Date 11/ ...

  20. Modeling of an optimized electrostimulative hip revision system under consideration of uncertainty in the conductivity of bone tissue.

    Schmidt, Christian; Zimmermann, Ulf; van Rienen, Ursula

    2015-07-01

    Since several years, the number of total hip arthroplasty revision surgeries is substantially growing. One of the main reasons for this procedure to become necessary is the loosening or damage of the prothesis, which is facilitated by bone necrosis at the implant-bone interface. Electrostimulation is one promising technique, which can accelerate the growth of bone cells and, therefore, enhance the anchorage of the implant to the bone. We present computational models of an electrostimulative total hip revision system to enhance bone regeneration. In this study, the influence of uncertainty in the conductivity of bone tissue on the electric field strength and the beneficial stimulation volume for an optimized electrode geometry and arrangement is investigated. The generalized polynomial chaos technique is used to quantify the uncertainty in the stimulation volumes with respect to the uncertain conductivity of cancellous bone, bone marrow, and bone substitute, which is used to fill defective areas. The results suggest that the overall beneficial stimulation areas are only slightly sensitive to the uncertainty in conductivity of bone tissue. However, in the proximity of tissue boundaries, larger uncertainties, especially in the transition between beneficial and understimulation areas, can be expected. PMID:25898285

  1. Magnetic resonance imaging of labral cysts of the hip

    Schnarkowski, P. [Department of Radiology, University of California, San Francisco, CA (United States)]|[Department of Radiology, Ludwig-Maximilians-University, Munich (Germany); Steinbach, L.S. [Department of Radiology, University of California, San Francisco, CA (United States); Tirman, P.F.J. [Department of Radiology, University of California, San Francisco, CA (United States)]|[San Francisco Magnetic Resonance Center, San Francisco, CA (United States); Peterfy, C.G. [Department of Radiology, University of California, San Francisco, CA (United States); Genant, H.K. [Department of Radiology, University of California, San Francisco, CA (United States)

    1996-11-01

    Objective. To present the magnetic resonance (MR) imaging findings in patients with labral cysts adjacent to the acetabulum and to examine their association with hip pathology. Design. MR images and conventional radiographs of seven patients with paralabral cysts were retrospectively reviewed by three musculoskeletal radiologists. Patients. The patients included three men and four women with hip pain, ranging in age from 29 to 82 years. Two patients had developmental dysplasia of the hip and six had a history of remote trauma/dislocation. Clinical history and follow-up were obtained in all patients. Surgery was performed on one patient. Results and conclusions. Paralabral cysts were located in the posterosuperior aspect of the hip joint in five patients and in the anterior aspect in two patients. A tear of the adjacent acetabular labrum was confirmed surgically in one patient, and in all patients the MR features suggested the presence of an abnormal labrum. Osteoarthritis was observed in three patients and there was associated subchondral cyst formation in the acetabulum adjacent to the cyst in three patients. The paralabral cyst of the hip is well visualized on MR imaging and is seen in patients with a predisposition to labral pathology. (orig.). With 3 figs., 1 tab.

  2. Effect of increased pushoff during gait on hip joint forces.

    Lewis, Cara L; Garibay, Erin J

    2015-01-01

    Anterior acetabular labral tears and anterior hip pain may result from high anteriorly directed forces from the femur on the acetabulum. While providing more pushoff is known to decrease sagittal plane hip moments, it is unknown if this gait modification also decreases hip joint forces. The purpose of this study was to determine if increasing pushoff decreases hip joint forces. Nine healthy subjects walked on an instrumented force treadmill at 1.25 m/s under two walking conditions. For the natural condition, subjects were instructed to walk as they normally would. For the increased pushoff condition, subjects were instructed to "push more with your foot when you walk". We collected motion data of markers placed on the subjects' trunk and lower extremities to capture trunk and leg kinematics and ground reaction force data to determine joint moments. Data were processed in Visual3D to produce the inverse kinematics and model scaling files. In OpenSim, the generic gait model (Gait2392) was scaled to the subject, and hip joint forces were calculated for the femur on the acetabulum after computing the muscle activations necessary to reproduce the experimental data. The instruction to "push more with your foot when you walk" reduced the maximum hip flexion and extension moment compared to the natural condition. The average reduction in the hip joint forces were 12.5%, 3.2% and 9.6% in the anterior, superior and medial directions respectively and 2.3% for the net resultant force. Increasing pushoff may be an effective gait modification for people with anterior hip pain. PMID:25468661

  3. Ranking of computed tomography in congenital hip dysplasia and hip dislocation

    Lingg, G.; Nebel, G.; Thomas, W.; Hering, L.

    1983-12-01

    A lot of methods of measurement have been developed to record precisely the degrees of luxation and the deviations from the normal form in the hip joints of the child and adult. The orthopaedic surgeon needs those data for a preoperative ''coxometric program'' before performing acetabuloplastic operations with osteotomia, osteotomia of the pelvis and combined operations. Computed tomography yields a series of informations and of possibilities of measurements which can determine the operative procedure in particular. These informations concern among other things the dimensions of the dysplasia of the acetabulum in the horizontal plane with the extension of the posterior lip and the angle of the acetabular opening, furthermore the physiological or pathological congruence between the head of the femur and the acetabulum, the angle of antetorsion of the neck of the femur and, in the small infant, the direct noninvasive imaging of the tube of the capsule with imaging of possible obstacles to reposition.

  4. Support for total hip replacement surgery: Structures modeling, Gait Data Analysis and Report system

    Gianluca Mario Izzo

    2012-03-01

    Full Text Available For the treatment of advanced damages of hip joints, Total Hip Arthroplasty is well proven. Due to the different mechanical properties of the prosthesis material and the bone tissue, a partial unloading of the periprosthetic bone occurs. The bone cement causes reduction in bone density as a result of removal of normal stress from the bone, leading to weakening of the bone in that area and the fracture risk increases. Bone loss is identified as one of the main reasons for loosening of the stem. Otherwise, thanks to the press-fit of the non-cemented stem achieved by surgery, the bone layers immediately adjacent to the stem are preloaded, thus encouraged growing, and the bone getting stronger. The non-cemented stem would be the better choice for every patient, but the question remains if the femur can handle the press- fitting surgery. This studies aim to develop a monitoring techniques based on Gait analysis and bone density changes to assess patient recovery after Total Hip Arthroplasty. Furthermore, to validate computational processes based on 3D modeling and Finite Element Methods for optimizing decision making in the operation process and selecting the suited surgical procedure. A vision could be minimizing risk of periprosthetic fracture during and after surgery. Patients: The sample presents 11 patients receiving cemented implant and 13 for the uncemented. Patients are grouped by type of implant. Three checkpoints were considered: before, after operation and one year later. CT scans, gaitrite and kinepro measurements have been realized. Main outcome measures: Fracture risk probability is higher in bone with low bone mineral density; therefore bones are more fragile in elderly people. BMD is indeed one parameter considered among all the observations. Periprosthetic fracture of the femur is a rare but complex complication of THA, and requires demanding surgery. As such, they result in considerable morbidity and dysfunction. Thus, tests of

  5. Radiographic assessment of developmental dysplasia of the hip – A novel radiology reporting process and one year review of referrals

    Introduction: Developmental dysplasia of the hip (DDH) is the most common musculoskeletal disorder of childhood. Despite the introduction of ultrasound screening radiography remains the most common imaging investigation for children over 4–6 months. The use of picture archive and communications system (PACS) tools to review key measures is standard but annotation of these images supplemented by a radiology report has not been described previously. Method: Referral and demographic data were identified of all children under the age of 2 years attending for a non-trauma pelvic radiograph within a single NHS Trust between January and December 2012. Retrospective review of all radiographs and reports identified the clinical history, co-morbidities and outcome. Results: A total of 313 referrals were received, 230 initial and 83 follow-up examinations. 37 examinations identified a dysplastic acetabulum (n = 37/230; 16.1%) with the majority being girls (n = 23/37; 62.1%). A total of 25 abnormal findings in relation to the femoral head epiphyses were identified (n = 25/230; 10.9%) with 12 also having acetabular dysplasia. Children with a dysplastic acetabulum were significantly more likely to have a subluxation or dislocation (X2 183.78, 2df, p ≤ 0.001). Children with acetabular dysplasia were significantly more likely to have been born in the autumn or winter months (proportional difference = 11.0%; 95% CI [0.019,0.202]; p = 0.024). Conclusion: This article presents a novel reporting process which is helping to standardise the results in young children undergoing investigation for DDH. The review of referrals confirmed the published evidence that DDH is more prevalent in girls and children born in the autumn and winter months

  6. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty

    Tomas, Xavier; Garcia-Diez, Ana Isabel; Pomes, Jaime [Universidad de Barcelona, Department of Radiology, Hospital Clinic, Barcelona (Spain); Bori, Guillem; Garcia, Sebastian; Gallart, Xavier; Martinez, Juan Carlos; Riba, Josep [Universidad de Barcelona, Department of Orthopaedics, Hospital Clinic, Barcelona (Spain); Soriano, Alex; Mensa, Josep [Universidad de Barcelona, Department of Infectious Diseases, Hospital Clinic, Barcelona (Spain); Rios, Jose [Statistical Unit de Suport a la Estadistica I Metodologia IDIBAPS, Barcelona (Spain); Almela, Manel [Universidad de Barcelona, Department of Microbiology, Hospital Clinic, Barcelona (Spain)

    2011-01-15

    To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery. Sixty-three patients (35 women and 28 men; age range, 29-86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients. Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P = 0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher's exact test, the presence of periprosthetic fluid collections (P = 0.001), prosthetic acetabular malposition (P = 0.025) and aspirated fluid volume (P = 0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P = 0.429). Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis. (orig.)

  7. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty

    To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery. Sixty-three patients (35 women and 28 men; age range, 29-86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients. Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P = 0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher's exact test, the presence of periprosthetic fluid collections (P = 0.001), prosthetic acetabular malposition (P = 0.025) and aspirated fluid volume (P = 0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P = 0.429). Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis. (orig.)

  8. Quantitative MRI Evaluation of Articular Cartilage Using T2 Mapping Following Hip Arthroscopy for Femoroacetabular Impingement

    Mayer, Stephanie W.; Wagner, Naomi; Fields, Kara G.; Wentzel, Catherine; Burge, Alissa; Potter, Hollis G.; Lyman, Stephen; Kelly, Bryan T.

    2016-01-01

    Objectives: Cam-type femoroacetabular impingement (FAI) causes a shearing and delamination injury to the acetabular articular cartilage due to a mismatch between the size of the femoral head and the acetabulum. This mechanism is thought to lead to early osteoarthritis in this population. Cam decompression has been advocated to eliminate impingement, with the ultimate goal of halting the progression of articular cartilage delamination. Although outcomes following this procedure in the young adult population have been favorable at short and medium term follow up, it is not known whether the articular cartilage itself is protected from further injury by changing the biomechanics of the joint with decompression of the cam morphology. The purpose of this study is to compare the pre- and post-operative integrity of the acetabular articular cartilage using T2 mapping to determine if hip arthroscopy is protective of the articular cartilage at short- to medium term follow up. Methods: Males between 18 and 35 years of age who had pre-operative T2 mapping MRIs, underwent hip arthroscopy for cam or mixed-type FAI with an alpha angle greater than 50°, and had at least 2 year follow-up were identified. Post-operative MRIs were performed and T2 relaxation times in the transition zone and weight bearing articular cartilage in the anterosuperior acetabulum at deep and superficial chondral layers were recorded at nine points on three sagittal sequences on pre and post-operative MRIs. A paired t-test was used to compare T2 relaxation values between pre-operative and post-operative scans. Results: Eleven hips were evaluated. Mean age was 26.3 years (range 21 - 35). Mean follow up time to post-operative T2 mapping MRI was 2.6 years (range 2.4 - 2.7). The change in T2 relaxation time was not significantly different between pre- and post-operative MRI scans for any of the nine regions in the deep zone of the acetabular cartilage (p=0.065 - 0.969) or the superficial zone of the

  9. Artroscopia do quadril em atletas Hip arthroscopy in athletes

    Giancarlo Cavalli Polesello

    2009-02-01

    Full Text Available OBJETIVO: Confirmar a importância terapêutica da artroscopia do quadril em atletas cuja dor impede a função desportiva da articulação do quadril, sendo capaz de minimizá-la a ponto de ajudar o retorno à atividade esportiva em níveis satisfatórios. MÉTODOS: Foram analisados 49 pacientes que praticam esporte (51 quadris, submetidos à artroscopia do quadril que apresentavam dor e incapacidade para a prática esportiva. O seguimento mínimo foi de 12 meses e o máximo de 74 meses (média de 39,0 meses. No período pré-operatório avaliou-se a localização da dor, sua intensidade segundo a Escala de Expressão Facial (EEF e o grau de incapacidade utilizando-se o critério de Harris Hip Score modificado (HHS. Anotaram-se diferentes diagnósticos que levaram à indicação da artroscopia, como impacto femoroacetabular, lesão do lábio acetabular não secundária ao impacto femoroacetabular e outros. No período pós-operatório, os pacientes foram avaliados pelos mesmos métodos do período pré-operatório e pela análise subjetiva de retorno ao esporte. RESULTADOS: Baseando-se no HHS e EEF pré e pós-operatórios, a análise estatística mostrou significância entre os valores. Observou-se alguma melhora em todos os casos e retorno ao esporte, de forma satisfatória, na maioria deles. CONCLUSÃO: Diante do que foi estudado, confirmamos que a artroscopia em atletas com lesões localizadas no quadril é técnica eficaz, capaz de promover o retorno à prática esportiva na maioria dos casos, sem dor e com função articular efetiva, desde que bem indicada.OBJECTIVE: To confirm the therapeutic importance of hip arthroplasty in athletes whose pain precludes sportive function of the hip joint, being able to minimize it to the extent of helping on the return of sports practice at satisfactory levels. METHODS: 49 athlete patients (51 hips submitted to hip arthroscopy complaining of pain and inability to practice sports were assessed. Follow

  10. Estimation of appropriate lubricating film thickness in ceramic-on-ceramic hip prostheses

    Tauviqirrahman, M.; Muchammad, Bayuseno, A. P.; Ismail, R.; Saputra, E.; Jamari, J.

    2016-04-01

    Artificial hip prostheses, consisting of femoral head and acetabular cup are widely used and have affected the lives of many people.However, the primary issue associated with the long term performance of hip prostheses is loosening induced by excessive wear during daily activity. Therefore, an effective lubrication is necessary to significantly decrease the wear. To help understand the lubricating performance of such typical hip joint prostheses, in the present paper a hydrodynamic lubrication model based on Reynolds equationwas introduced. The material pairs of ceramic acetabular cup against ceramic femoral head was investegated.The main aim of this study is to investigate of the effect of loading on the formation of lubricating film thickness.The model of a ball-in-socket configuration was considered assuming that the cup was stationary while the ball was to rotate at a steady angular velocityvarying loads.Based on simulation result, it was found that to promote fluid film lubrication and prevent the contacting components leading to wear, the film thickness of lubricant should be determined carefully based on the load applied. This finding may have useful implication in predicting the failure of lubricating synovial fluid film and wear generation in hip prostheses.

  11. Computer aided diagnosis and treatment planning for developmental dysplasia of the hip

    Li, Bin; Lu, Hongbing; Cai, Wenli; Li, Xiang; Meng, Jie; Liang, Zhengrong

    2005-04-01

    The developmental dysplasia of the hip (DDH) is a congenital malformation affecting the proximal femurs and acetabulum that are subluxatable, dislocatable, and dislocated. Early diagnosis and treatment is important because failure to diagnose and improper treatment can result in significant morbidity. In this paper, we designed and implemented a computer aided system for the diagnosis and treatment planning of this disease. With the design, the patient received CT (computed tomography) or MRI (magnetic resonance imaging) scan first. A mixture-based PV partial-volume algorithm was applied to perform bone segmentation on CT image, followed by three-dimensional (3D) reconstruction and display of the segmented image, demonstrating the special relationship between the acetabulum and femurs for visual judgment. Several standard procedures, such as Salter procedure, Pemberton procedure and Femoral Shortening osteotomy, were simulated on the screen to rehearse a virtual treatment plan. Quantitative measurement of Acetabular Index (AI) and Femoral Neck Anteversion (FNA) were performed on the 3D image for evaluation of DDH and treatment plans. PC graphics-card GPU architecture was exploited to accelerate the 3D rendering and geometric manipulation. The prototype system was implemented on PC/Windows environment and is currently under clinical trial on patient datasets.

  12. A porous tantalum uncemented acetabular cup in acetabular revision arthroplasty%生物学固定骨小梁金属杯在髋臼翻修中的应用

    徐卫东; 陈刚; 张东华

    2009-01-01

    前后X射线平片显示无假体移位下沉等不稳迹象,骨小梁金属杯周围骨质向内长入.本组患者无置换后并发症发生,截至最后1次随访有14例行走时无疼痛,2例轻度疼痛伴轻度跛行.未出现症状性深静脉血栓或神经损伤.无需要再度翻修病例.结论:初次固定人工髋臼杯失败的病例,若无骨缺损,翻修时使用骨小梁金属杯可以获得良好的早期效果.%BACKGROUND: Biological fixation refers to the treatment of coarse or porous prosthetic surface. It is favorable to "bone ingrowth" prosthesis to achieve long-term stability. Porous tantalum is the latest scientific product that appears suitable to prosthetic surface owing to its porous feature and has been attracting a great deal attention.OBJECTIVE: To investigate the therapeutic efficacy of a porous tantalum uncemented acetabular cup in acetabular revision arthroplasty.DESIGN, TIME AND SETTING: A retrospective case analysis was performed at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA between April and November 2006.PARTICIPANTS/MATERIALS: Sixteen patients (16 hips), 7 males and 9 females, aged 54-81 years old, who received treatment at the Department of Orthopedics, Changhai Hospital, Second Military Medical University of Chinese PLA were included in this study. Of these patients, 2 suffered from femoral neck fracture, 6 from aseptic femoral head necrosis, and 8 from osteoarthritis. Trabecular metal cup (Zimmer, Warsaw, Indiana) provided a titanium alloy bottom layer and porous tantalum-coated surface, which was realized by technical combination of bone trabecular tantalum and titanium alloy. The prosthesis contained an ultrahigh modulus polyethylene lining.METHODS: All patients underwent acetabular revision with modular porous tantalum uncemented acetabular cup. Prior to replacement, acetabular defects and femoral prosthesis were evaluated. A posterolateral approach of hip joint was made. Following

  13. Hip injuries in children and adolescents.

    Craig, C L

    1980-10-01

    Hip injuries in children present a wide spectrum of problems. Frequently because of the severity of the trauma involved, other injuries may take precedence and may require modification of the usual approaches to treatment. However, certain precepts are essential to the successful treatment of these injuries and should be kept in mind regardless of the milieu in which they are found. In the child with a hip dislocation, the potential presence of an acetabular, femoral head, femoral shaft, patellar or tibial plateau fracture must always be considered. Specialized x-ray views are necessary for this evaluation. Laminography and arthrography may also be required. The essential feature of successful subsequent treatment is a gentle closed reduction performed within 24 hours of injury. Treatment of displaced fractures of the femoral neck remains an unresolved issue. Accurate reduction held with adequate internal fixation would appear to offer the best chance for a successful result. The possible complications of avascular necrosis, delayed union and non-union, coxa vara, premature closure of the epiphyseal plate, and shortening should be appreciated. Early institution of appropriate treatment may mitigate the ultimate effect of these potentially devastating problems. PMID:7454245

  14. Roles of radiograph, magnetic resonance imaging, threedimensional computed tomography in early diagnosis of femoro-acetabular impingement in 17 cases

    GU Gui-shan; ZHU Dong; WANG Gang; WANG Cheng-xue

    2009-01-01

    Objective: To evaluate the roles of radiograph, magnetic resonance imaging (MRI), three-dimensional computed tomography (3-D CT) in early diagnosis of femoro-acetabular impingement (FAI) in 17 cases. Methods: Plain radiographs of the pelvis, 3-D CT, and MRI of the hip were made on 17 patients with groin pain, which was worse with prolonged sitting (i.e. hip flexion). There was no history of trauma or childhood hip disorders in the patients who did not complain of any other joint problems or neurologic symptoms. All patients had positive anterior or posterior impingement test. Plain radiographs included an antero-posterior (AP) view of the hip and a cross table lateral view with slight internal rotation of the hip. CT scan was performed with the Lightspeed 16 row spiral (General Electric Company, USA) at 1.25 mm slice reconstruction. MRI scan was performed on the Siemens Avanto (Siemens Company, Germany)1.5T supraconducfion magnetic resonance meter. The CT and MRI scans were taken from 1 cm above the acetabulum to the lesser trochanter in 5 series. Results: The plain radiographs of the pelvis showed that among the 17 patients, 12 (70.59%) had "Cam" change of the femoral head, 6 (35.29%) had positive "cross-over" sign, and 17 (100%) had positive "Pincer" change of the acetabulum. The 16 row spiral CT noncontrast enhanced scan and 3-D reconstruction could discover minus femoral offset and ossification and osteophyte of the acetabulum labrum in all the 17 cases (100%). The MRI noncontrast enhanced scan could discover more fluid in the hip joint in 15 cases (88.33%), subchondral ossification in 3 cases (17.6%), and labium tears in 3 cases (17.6%). Conclusions: Plain radiographs can provide the initial mainstay for the diagnosis of FAI, 3-D CT can tell us the femoral offset, while MRI can show labrum tears in the very early stage of FAI. Basically, X-ray examination is enough for the early diagnosis of FAI, but 3-D CT and MRI may be useful for the treatment.

  15. Ultrasound: Infant Hip

    ... ultrasound when they suspect a problem called developmental dysplasia of the hip (DDH) . DDH is a hip deformity that can ... THIS TOPIC X-Ray Exam: Leg Length Developmental Dysplasia of the Hip X-Ray Exam: Hip Contact Us Print Resources ...

  16. FE Analysis of Non-Uniform Cement Layer in Acetabular Cup of Hip Joint Implant

    Vyčichl, Jan; Kunecký, Jiří; Kytýř, Daniel; Jírová, Jitka

    Plzeň : Západočeská univerzita, 2007, s. 30-31. ISBN 978-80-7043-607-3. [The 1st IMACS International Conference on Computational Biomechanics and Biology ICCBB 2007. Plzeň (CZ), 10.09.2007-13.09.2007] R&D Projects: GA AV ČR(CZ) IAA200710504 Institutional research plan: CEZ:AV0Z20710524 Keywords : pelvic bone * acetabulum * cement layer * FE model Subject RIV: BO - Biophysics

  17. Long-term evolution of slipped capital femoral epiphysis treated by in situ fixation: a 26 years follow-up of 11 hips

    Jérôme Murgier

    2014-06-01

    Full Text Available Slipped capital femoral epiphysis (SFCE may lead to femoro acetabular impingement and long-term function impairment, depending on initial displacement and treatment. There are several therapeutic options which include in situ fixation (ISF. The objective of this study was to evaluate long-term functional and radiographic outcomes of patients with SFCE treated with ISF. We conducted a single-center, retrospective study evaluating the clinical and radiographic outcomes of SCFE in situ fixation with a mean follow-up of 26 years (10- 47. Analysis of preoperative and last follow up radiographs was performed. The functional status of the hip was evaluated according to the Oxford hip score-12 and the radiographic osteoarthritis stage was rated according to Tönnis classification. Signs of femoro acetabular impingement were sought. Ten patients (11 hips were included. The average initial slip was 33.5° (10-62. At final follow up, the average Oxford hip score was 19.3 (12-37, it was good for groups who had a small initial slip (16.7 or moderate (17 and fair for the severe group (27. Average Tönnis grade was 1.3 (0- 3. The average alpha angle was 65.3° (50- 80°. Femoro acetabular impingement was likely in 100% of patients with severe slip, in 50% of patients with moderate slip and in 33% of patients with a slight slip. In situ fixation generated poor functional results, substantial hip osteoarthritis and potential femoro acetabular impingement in moderate to severe SCFE’s. However, in cases with minor displacement, functional and radiographic results are satisfactory. The cut off seems to be around 30° slip angle, above which other treatment options should be considered.

  18. The effect of posterior capsule repair upon post-operative hip dislocation following primary total hip arthroplasty

    Wang Chen-Ti

    2008-02-01

    Full Text Available Abstract Background Herein, we evaluated, retrospectively, the effect of posterior capsular repair upon postoperative hip dislocation subsequent to total hip arthroplasty (THA incorporating a posterolateral approach. Methods A total of 181 patients undergoing 204 primary non-complicated THA surgical procedures in the period from January 2000 to October 2005 inclusively were included in this study. The patients were separated into two groups by whether the posterior capsular repair had been incorporated in the surgical procedure. For the surgeon did not commence repairing the posterior capsule until July, 2003, all members in the group that did not undergo posterior capsular repair (142 hips from 131 patients were collected since January, 2000 to July, 2003, while the members in the group that underwent posterior capsular repair (62 hips from 52 patients were followed since July, 2003, to October, 2005. With a minimum follow-up period of 12 months, we evaluated the early post-operative dislocation rate. Results The early postoperative hip-dislocation rate for the group who did not undergo posterior capsular repair appeared to be substantially greater (6.38% versus 0% than the corresponding figure for the group the members of which underwent posterior capsular repair. In addition, patient demographics and the orientation of acetabular components for the replaced hip joints, as presented in postoperative radiographs, did not differ between the two groups. Conclusion Thus, surgeons should include posterior capsular repair as an important step in the surgical procedures of posterolateral approach for all THA in order to reduce the likelihood of early hip dislocation subsequent to THA.

  19. Taper Hip Prosthesis

    Full Text Available ... get very nice exposure of our acetabular fossa. Let’s go deep, deep. Now in terms of patient positioning ... very easily without pounding and only after that -- let’s go up on 1 now. I've noticed that ...

  20. Taper Hip Prosthesis

    Full Text Available ... you using? We'll use the Zimmer trabecular metal acetabular component in a modular fashion today. My ... here, guys. Got a cup? Here’s our trabecular metal cup. For the tolls, we'll use a ...

  1. Using digital templating to predict the size of prosthesis in total hip arthroplasty%数字化模板测量在选择髋关节假体中的应用

    张鹏; 黄勇; 万连平; 刘泽淼; 张代勇

    2010-01-01

    Objective To evaluate application of the measurement methods of digital templates to select an hip prosthesis. Methods From January 2005 to February 2007, 122 patients (132 hips), including 68 males and 54 females, were studied. The hospital network system of digital imaging and digital templates on the computer were applied in preoperative template measurement of total hip replacement. For the sur-geon group and radiologist group, digital template measurements were used to predict the required size of models, and to compared with the actual prosthesis used in the operation. Results Surgeon group acetabu-lar prosthesis model and femoral prosthesis model hefore and after surgery were no significant difference be-tween measurements (Z=0.4531, P=0.6505; Z=0.5452, P=0.5856). Surgeon predicted preoperative acetabular prosthesis model with intraoperative acetabular prosthesis significant correlation between the models (r= 0.9361, P=0.0068), preoperative surgenn predict femoral prosthesis model with intraoperative application of femoral prosthesis significant correlation between the models (r=0.9435, P=0.0087). Acetabular prosthesis model and femoral prosthesis model of radiologist group, before and after surgery, were no difference between measurements (Z=0.6834, P=0.4934; Z=0.1027, P=0.8990). Radiologist preoperative prediction model of ac-etabular prosthesis with intraoperative acetabular prosthesis significant correlation between the models (r= 0.9214, P=0.0051), preoperative radiologist prediction model with the femoral prosthesis surgery Application of femoral prosthesis significant correlation between type (r=0.9357, P=0.0072). Total hip arthroplasty using the digital measurement of choice prosthesis template model and the practical application of prosthesis surgery models, compared acetabular prosthesis accuracy rate of 71.59%, femoral prosthesis 78.04% accura-cy rate. Conclusion The measurement of preoperative digital template design, selection of artificial

  2. Relation between the ultrasound and x-ray imaging of the infant hip joint

    The function of the imaging in DDH is very important. Ultrasound of the infant hip has gained acceptance since its introducing by Graf in 1980. It id an easily accessible real-time technique, is available at reasonable cost and does not expose the patient to ionizing radiation or require sedation; and addition, the equipment is portable. Conversely, ultrasound of the hip must be performed by an experienced sonographer and images must be obtained in two orthogonal planes (axial and coronal). Furthermore, measurements of acetabular angles can be time consuming. Recognizing these advantages and challenges, we originated a project sonographic technology to determine the strengths and limitation of this new imaging tool. Of the infants brought to out patient department of the clinic, radiographs were made when hip dislocation was clinically and sonographically suspected. (author)

  3. Treatment of Hip Dysplasia in a Dog after a Failed Triple Pelvic Osteotomy with a Zurich Cementless Total Hip Replacement

    SY Heo and H.B Lee*

    2013-07-01

    Full Text Available An Alaskan Malamute (2-year-old, castrated male, 41kg was referred with bilateral hind limb lameness. The dog had a history of a bilateral triple pelvic osteotomy (TPO to correct hip dysplasia one year previously, a surgery that was unsuccessful. On physical examination, pain and crepitus were noted in both hip joints. There was hip joint subluxation and mild degenerative changes bilaterally seen by radiograph. A Zurich cementless total hip replacement (ZCTHR was planned for the right hind limb. After a craniolateral approach, an acetabular cup and a cementless femoral stem were implanted. The femoral head was placed in the femoral stem, and the prosthetic joint was then reduced. At a 9 month postoperative checkup, there was no pain on palpation or manipulation of the right pelvic limb, and the range of motion was within normal limits. On radiological examination, there was no implant loosening. The ZCTHR can thus be applied in a failed TPO patient as a revision surgery.

  4. Preliminary results of a randomized trial comparing 400 cGy vs 700 cGy as an adjuvant to prevent heterotopic ossification after total hip arthroplasty

    Purpose/Objective: We report our preliminary results of a randomized trial comparing one single dose of 400 cGy versus 700 cGy given postoperatively in an attempt to prevent heterotopic ossification after total hip arthroplasty. Materials and Methods: From 09/1993 and 05/1996, over 800 total hip replacements were performed at our hospital. From this group of patients, 120 hips in 114 high-risk patients (14%) were enrolled in a randomized trial to determine if 400 cGy (Group A) is as efficacious as 700 cGy (Group B) in preventing heterotopic ossification. In Group A, there were 42 males (46 hips) and 12 females (12 hips) with a mean age of 60 (range 41-79); with 18 primary cementless femoral components (33%), 30 primary cemented stems (55%) and 10 revisions. In Group B, there were 30 males (32 hips) and 30 females (31 hips) with a median age of 59 (range 41-85); with 12 primary cementless femoral components (20%), 44 primary cemented stems (73%) and 6 revisions. All acetabular components were of the cementless type. Patients were randomized to receive either 400 cGy or 700 cGy in one fraction. Radiotherapy is given within 48 hours post-operatively using paired anterior and posterior fields, with blocking of the cementless acetabular component and the femoral component. Results: All 114 patients were available for a minimum follow-up of 6 months (range 6-30 months). None of the arthroplasties has failed at the latest follow-up. There were no radiation therapy complications noted. Statistical analysis revealed no difference in the distribution of patients in either group according to age, sex, primary or revision arthroplasty, cemented or cementless femoral component fixation, preoperative heterotopic ossification risk, or surgical approach. Of the 58 hips in Group A, heterotopic ossification was graded as Grade 0 in 24 hips, Grade I in 10 hips, Grade II in 18 hips, Grade III in 6 hips, with no cases of Grade IV. Of the 63 hips in Group B, heterotopic ossification was

  5. 7 Tesla quantitative hip MRI: T1, T2 and T2* mapping of hip cartilage in healthy volunteers

    Lazik, Andrea; Theysohn, Jens M.; Geis, Christina [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); Johst, Soeren; Kraff, Oliver [University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); Ladd, Mark E. [University Hospital Essen, Department of Diagnostic and Interventional Radiology and Neuroradiology, Essen (Germany); University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); German Cancer Research Center (DKFZ), Medical Physics in Radiology, Heidelberg (Germany); Quick, Harald H. [University of Duisburg-Essen, Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen (Germany); University Hospital Essen, High Field and Hybrid MR Imaging, Essen (Germany)

    2016-05-15

    To evaluate the technical feasibility and applicability of quantitative MR techniques (delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), T2 mapping, T2* mapping) at 7 T MRI for assessing hip cartilage. Hips of 11 healthy volunteers were examined at 7 T MRI with an 8-channel radiofrequency transmit/receive body coil using multi-echo sequences for T2 and T2* mapping and a dual flip angle gradient-echo sequence before (T1{sub 0}) and after intravenous contrast agent administration (T1{sub Gd}; 0.2 mmol/kg Gd-DTPA{sup 2-} followed by 0.5 h of walking and 0.5 h of rest) for dGEMRIC. Relaxation times of cartilage were measured manually in 10 regions of interest. Pearson's correlations between R1{sub delta} = 1/T1{sub Gd} - 1/T1{sub 0} and T1{sub Gd} and between T2 and T2* were calculated. Image quality and the delineation of acetabular and femoral cartilage in the relaxation time maps were evaluated using discrete rating scales. High correlations were found between R1{sub delta} and T1{sub Gd} and between T2 and T2* relaxation times (all p < 0.01). All techniques delivered diagnostic image quality, with best delineation of femoral and acetabular cartilage in the T2* maps (mean 3.2 out of a maximum of 4 points). T1, T2 and T2* mapping of hip cartilage with diagnostic image quality is feasible at 7 T. To perform dGEMRIC at 7 T, pre-contrast T1 mapping can be omitted. (orig.)

  6. FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF ACETABULAR FRACTURES BY INTERNAL FIXATION

    Sagar

    2015-06-01

    Full Text Available BACKGROUND: The treatment of acetabular fractures has seen major advances in the field of orthopaedic traumatology. Conservative treatment of acetabular fractures leads to poor results. Newer diagnostic tools like the Computed Tomography (CT scan help in analyzing the three dimensional disturbance in the normal anatomy and plan the surgical management accordingly. In recent years operative treatment has become the treat ment of choice in the management of acetabular fractures as precise anatomical reduction with adequate internal fixation can be attained. OBJECTIVES : To evaluate the functional outcome of operatively managed acetabular fractures , and assess the efficacy of operative fixation of acetabular fractures , and also study the complications of operative fixation of acetabular fractures. MATERIALS AND METHODS: Fifty five patients (49 male & six female admitted to Sanjay Gandhi Institute of Trauma and Orthopaedics wi th acetabular fractures underwent open reduction and internal fixation. All patients were evaluated with Matta et al score with a minimum of follow up of six months. RESULTS: There were 24 (43.6% patients with bicolumnar fractures , 15(27.3% had posterior column fractures , 10(18.1% had posterior wall fractures , five (9.1% had transverse fractures , and one (1.8% patient had an anterior column fracture. Full weight bearing was attained in thirty five (63.6% patients in 16 weeks and in twenty (36.4% pati ents after 16 weeks. Forty five (81.8% patients were free of complications. According to Matta et al score 27(49.1% had excellent , 15(27.3% had good , nine (16.4% had fair , and four (7.3% had poor results. CONCLUSION: Open reduction and internal fixati on of acetabular fractures is a reliable technique , minimizes healing time and provides congruent joint reduction. Operative treatment of acetabular fractures results in predictable union and good clinical results with a low rate of complications.

  7. Subchondral Insufficiency Fracture of the Femoral Head Caused by Excessive Lateralization of the Acetabular Rim

    Kimura, Tetsuya; Goto, Tomohiro; Hamada, Daisuke; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage. PMID:27293935

  8. Computer assisted determination of acetabular cup orientation using 2D-3D image registration

    2D-3D image-based registration methods have been developed to measure acetabular cup orientation after total hip arthroplasty (THA). These methods require registration of both the prosthesis and the CT images to 2D radiographs and compute implant position with respect to a reference. The application of these methods is limited in clinical practice due to two limitations: (1) the requirement of a computer-aided design (CAD) model of the prosthesis, which may be unavailable due to the proprietary concerns of the manufacturer, and (2) the requirement of either multiple radiographs or radiograph-specific calibration, usually unavailable for retrospective studies. In this paper, we propose a new method to address these limitations. A new formulation for determination of post-operative cup orientation, which couples a radiographic measurement with 2D-3D image matching, was developed. In our formulation, the radiographic measurement can be obtained with known methods so that the challenge lies in the 2D-3D image matching. To solve this problem, a hybrid 2D-3D registration scheme combining a landmark-to-ray 2D-3D alignment with a robust intensity-based 2D-3D registration was used. The hybrid 2D-3D registration scheme allows computing both the post-operative cup orientation with respect to an anatomical reference and the pelvic tilt and rotation with respect to the X-ray imaging table/plate. The method was validated using 2D adult cadaver hips. Using the hybrid 2D-3D registration scheme, our method showed a mean accuracy of 1.0 ± 0.7 (range from 0.1 to 2.0 ) for inclination and 1.7 ± 1.2 (range from 0.0 to 3.9 ) for anteversion, taking the measurements from post-operative CT images as ground truths. Our new solution formulation and the hybrid 2D-3D registration scheme facilitate estimation of post-operative cup orientation and measurement of pelvic tilt and rotation. (orig.)

  9. Computer assisted determination of acetabular cup orientation using 2D-3D image registration

    Zheng, Guoyan; Zhang, Xuan [University of Bern, Institute for Surgical Technology and Biomechanics, Bern (Switzerland)

    2010-09-15

    2D-3D image-based registration methods have been developed to measure acetabular cup orientation after total hip arthroplasty (THA). These methods require registration of both the prosthesis and the CT images to 2D radiographs and compute implant position with respect to a reference. The application of these methods is limited in clinical practice due to two limitations: (1) the requirement of a computer-aided design (CAD) model of the prosthesis, which may be unavailable due to the proprietary concerns of the manufacturer, and (2) the requirement of either multiple radiographs or radiograph-specific calibration, usually unavailable for retrospective studies. In this paper, we propose a new method to address these limitations. A new formulation for determination of post-operative cup orientation, which couples a radiographic measurement with 2D-3D image matching, was developed. In our formulation, the radiographic measurement can be obtained with known methods so that the challenge lies in the 2D-3D image matching. To solve this problem, a hybrid 2D-3D registration scheme combining a landmark-to-ray 2D-3D alignment with a robust intensity-based 2D-3D registration was used. The hybrid 2D-3D registration scheme allows computing both the post-operative cup orientation with respect to an anatomical reference and the pelvic tilt and rotation with respect to the X-ray imaging table/plate. The method was validated using 2D adult cadaver hips. Using the hybrid 2D-3D registration scheme, our method showed a mean accuracy of 1.0 {+-} 0.7 (range from 0.1 to 2.0 ) for inclination and 1.7 {+-} 1.2 (range from 0.0 to 3.9 ) for anteversion, taking the measurements from post-operative CT images as ground truths. Our new solution formulation and the hybrid 2D-3D registration scheme facilitate estimation of post-operative cup orientation and measurement of pelvic tilt and rotation. (orig.)

  10. Analysis of bone formation on porous and calcium phosphate-coated acetabular cups: a randomised clinical [18F]fluoride PET study.

    Ullmark, Gösta; Sörensen, Jens; Nilsson, Olle

    2012-01-01

    We present a study using Fluoride-Positron Emission Tomography (F-PET/CT) to analyse new bone formation in periacetabular bone adjacent to press fit cups following THA. In 16 THA (8 patients) with bilateral hip osteoarthritis simultaneous bilateral total hip arthroplasty (THA) was performed, employing electrochemically applied calcium phosphate coated (HA) cups or porous-coated (PC) cups allocated at random to compare the two sides. A reference group of 13 individuals with a normal healthy hip was used to determine 'normal' bone metabolism. [18F]fluoride -PET/CT was used to analyze bone formation adjacent to the cups 1 week, 4 months and 12 months after surgery. Clinical and radiographic evaluation was performed preoperatively, postoperatively and at 2 years. Bone forming activity had a mean of 5.71, 4.69 and 3.47 SUV around the HA- and 5.04, 4.80 and 3.50 SUV around the PC-cups at 1 week, 4 months and 12 months respectively. Normal bone metabolism was 3.68 SUV. After 1 year activity had declined to normal levels for both groups. The clinical results were good in all cases. HA coating resulted in higher uptake indicating higher bone forming activity after 1 week. F-PET/CT is a valuable tool to analyse bone formation and secondary stabilisation of an acetabular cup. PMID:22547382

  11. Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants

    Владимир Евгеньевич Басков

    2016-06-01

    Full Text Available Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

  12. Dislocation of a dual mobility total hip replacement following fracture of the polyethylene liner.

    Vedrine, Bertrand; Guillaumot, Pierre; Chancrin, Jean-Luc

    2016-05-18

    An eight-year-old male English Setter was referred for management of a dislocation of a cemented dual mobility canine total hip prosthesis that occurred four months after the initial surgery. Revision surgery showed that the dislocation was associated with fracture of the ultra-high molecular weight polyethylene liner. The dislocation was successfully reduced after replacing the liner. A dual mobility acetabular component is composed of a mobile polyethylene liner inside a metallic cemented cup. Chronic wear of the components of a canine dual mobility total hip replacement has not been described previously. The use of this type of implant is fairly recent and limited long term follow-up of the implanted cases may be the explanation. Acute rupture of a polyethylene liner has never been described in humans, the only case of rupture of a polyethylene liner occurred 10 years after implantation. The case presented here of rupture of the polyethylene liner of a dual mobility total hip replacement is a hitherto unreported failure mode in this model of acetabular cup in the dog. PMID:26991949

  13. Hip replacement - precautions

    ... Barker KL, Dewey ME, Sackley CM. Effectiveness of physiotherapy exercise following hip arthroplasty for osteoarthritis: a systematic ... to ask your doctor Hip replacement - discharge Preventing falls - what to ask your doctor Update Date 11/ ...

  14. Taper Hip Prosthesis

    Full Text Available ... the minimally invasive anterial lateral approach to the right hip in this gentleman. We're going to ... the anterior superior at the spine of the right hip. And at this point we'll begin. ...

  15. Hip pain is more frequent in severe hip displacement: a population-based study of 77 children with cerebral palsy.

    Ramstad, Kjersti; Terjesen, Terje

    2016-05-01

    The aim of this study was to assess whether hip pain was associated with radiographic hip displacement (migration percentage, MP) in a population-based cohort of children with cerebral palsy. Seventy-seven children, mean age 9.5 (SD 1.6) years and Gross Motor Function Classification System level III-V, were assessed. Caregivers responded to the Child Health Questionnaire pain questions and located recurrent pain on a body map. Hip pain was reported in 22 children (29%) and 27 hips (18%). Hip pain was significantly more frequent in hips with MP more than or equal to 50%, in children with spastic quadriplegia, and in those with Gross Motor Function Classification System level V. We conclude that severe hip displacement with MP more than or equal to 50% was associated with hip pain, whereas slight or moderate subluxation did not influence the occurrence of such pain. PMID:26895291

  16. [Juvenile hip dislocation and the Vojta neuro-physiotherapy].

    Schütt, B

    1981-09-17

    Partial dislocation of the hip in case of cerebral palsy is a result of the disturbance of the neuromuscular system. Immobilization cannot improve the inadequate function the hip. A case of a girl is reported; stabilization of the hip after 3 years of neurophysio-therapy after Vojta could be achieved. PMID:7274945

  17. Hip Injuries and Disorders

    Your hip is the joint where your thigh bone meets your pelvis bone. Hips are called ball-and-socket joints because the ... a cup-like space in your pelvis. Your hips are very stable. When they are healthy, it ...

  18. Hip supporting device

    2011-01-01

    The present invention relates to a device for limiting movements in one or more anatomical joints, such as a device for limiting movement in the human hip joint after hip replacement surgery. This is provided by a device for limiting movement in the human hip joint, said device comprising: at least...

  19. An interactive surgical planning tool for acetabular fractures: initial results

    Marincek Borut

    2010-08-01

    Full Text Available Abstract Background Acetabular fractures still are among the most challenging fractures to treat because of complex anatomy, involved surgical access to fracture sites and the relatively low incidence of these lesions. Proper evaluation and surgical planning is necessary to achieve anatomic reduction of the articular surface and stable fixation of the pelvic ring. The goal of this study was to test the feasibility of preoperative surgical planning in acetabular fractures using a new prototype planning tool based on an interactive virtual reality-style environment. Methods 7 patients (5 male and 2 female; median age 53 y (25 to 92 y with an acetabular fracture were prospectively included. Exclusion criterions were simple wall fractures, cases with anticipated surgical dislocation of the femoral head for joint debridement and accurate fracture reduction. According to the Letournel classification 4 cases had two column fractures, 2 cases had anterior column fractures and 1 case had a T-shaped fracture including a posterior wall fracture. The workflow included following steps: (1 Formation of a patient-specific bone model from preoperative computed tomography scans, (2 interactive virtual fracture reduction with visuo-haptic feedback, (3 virtual fracture fixation using common osteosynthesis implants and (4 measurement of implant position relative to landmarks. The surgeon manually contoured osteosynthesis plates preoperatively according to the virtually defined deformation. Screenshots including all measurements for the OR were available. The tool was validated comparing the preoperative planning and postoperative results by 3D-superimposition. Results Preoperative planning was feasible in all cases. In 6 of 7 cases superimposition of preoperative planning and postoperative follow-up CT showed a good to excellent correlation. In one case part of the procedure had to be changed due to impossibility of fracture reduction from an ilioinguinal approach

  20. A reduction clamp for an aiming component in associated acetabular fractures

    Zhang-Fu Wang

    2015-01-01

    Full Text Available Background: The treatment of acetabular fractures is complex and requires specialized equipment. However, all currently available instruments have some disadvantages. A new reduction clamp that can firmly enable reduction and not hinder subsequent fixation procedures for some special fracture types is needed. Materials and Methods: In this study, we introduce a new acetabular clamp and its preliminary clinical application in three T-shaped acetabular fractures. Results: This new clamp can successfully pull the posterior column back to the anterior column and firmly maintain the reduction. This clamp′s aiming plate can facilitate the insertion of long lag screws. The clamp is also easy to assemble and use. Conclusion: This reduction clamp is a useful instrument that can facilitate open reduction and internal fixation of acetabular fractures.

  1. Use of computer assisted orthopedic surgery in pelvic and acetabular trauma

    Amr Abdelgawad; Ralitsa Akins; Kanlic, Enes M

    2011-01-01

    Computer assisted orthopedic surgery (CAOS) is a recent concept inorthopedics. Its use in orthopedic trauma is becoming more popular.Pelvic and acetabular trauma is one of the applications where CAOScan play an important role to facilitate the surgery. In this review article, we provide an overview of the structure of CAOS with specialemphasis on its role in pelvic and acetabular trauma. Th e use of CAOShas many advantages in the field of orthopedic trauma, however, manyobstacles are still pr...

  2. SeIectlng the incision In the surgical treatment of acetabular fractures

    Asik, Mehmet; Basturk, Sırrı; Akpinar, Sercan; Taser, Omer; Akalin, Yilmaz

    2004-01-01

    In acetabular fractures which may have totally differing three dimensional appearances selecting the incision directly influences the quality, directly influences the quality of the surgical reduction and, therefore, the postoperative clinical outcome of the patierit. Becauseof this, it is a subject that has to be meticulously done. According to the fracture types, we used 6 distinct incisions on the 35 acetabular fractures which were operated in our clinic between 1988 and 1992. We presente...

  3. Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases

    Tadatsugu Morimoto

    2015-01-01

    Full Text Available Sacral agenesis (SA is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip.

  4. The distribution of nociceptive innervation in the painful hip: a histological investigation.

    Haversath, M; Hanke, J; Landgraeber, S; Herten, M; Zilkens, C; Krauspe, R; Jäger, M

    2013-06-01

    Our understanding of the origin of hip pain in degenerative disorders of the hip, including primary osteoarthritis, avascular necrosis and femoroacetabular impingement (FAI), is limited. We undertook a histological investigation of the nociceptive innervation of the acetabular labrum, ligamentum teres and capsule of the hip, in order to prove pain- and proprioceptive-associated marker expression. These structures were isolated from 57 patients who had undergone elective hip surgery (44 labral samples, 33 ligamentum teres specimens, 34 capsular samples; in 19 patients all three structures were harvested). A total of 15,000 histological sections were prepared that were investigated immunohistochemically for the presence of protein S-100, 68 kDa neurofilament, neuropeptide Y, nociceptin and substance P. The tissues were evaluated in six representative areas. Within the labrum, pain-associated free nerve ending expression was located predominantly at its base, decreasing in the periphery. In contrast, the distribution within the ligamentum teres showed a high local concentration in the centre. The hip capsule had an almost homogeneous marker expression in all investigated areas. This study showed characteristic distribution profiles of nociceptive and pain-related nerve fibres, which may help in understanding the origin of hip pain. PMID:23723270

  5. Hip arthroscopy in the setting of hip dysplasia

    Yeung, M.; Kowalczuk, M.; Simunovic, N.; Ayeni, O. R.

    2016-01-01

    Objective Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to Ju...

  6. Do normal hips dislocate?

    Alshameeri, Zeiad; Rehm, Andreas

    2014-11-01

    There have been a small number of case reports describing late normal-hip dislocations in children who were later diagnosed with developmental dysplasia of the hip. Here, we contest the assumption that normal hips can dislocate. We argue that (as in our case) the ultrasound scans in all published case reports on late dislocated normal hips did not show results that were entirely normal and therefore, so far, there has been no convincing evidence of a dislocation of a normal hip. We also want to highlight the importance of meticulous ultrasound and clinical assessments of high-risk children by an experienced orthopaedic surgeon. PMID:25144883

  7. Canine hip dysplasia radiographic screening. Prevalence of rotation of the pelvis along its length axis in 7,012 conventional hip extended radiographs.

    Genevois, J-P; Cachon, T; Fau, D; Carozzo, C; Viguier, E; Collard, F; Remy, D

    2007-01-01

    The prevalence of rotation of the pelvis along its length axis was noted, as was the number of rotations towards the right or left hand side of the dog, on 7,012 conventional hip extended radiographs, which were sent for official screening. 29.8% of the radiographs showed a rotation the pelvis. The rotation was statistically more frequent towards the left hand side of the dog. The number of rejected radiographs for too important pelvis rotation was only 5.2%. The consequences of the pelvis rotation on the Norberg-Olsson angle, on the dorsal femoral head coverage, and in the aspect of cranial acetabular edge have to be taken into account when scoring the dog for hip dysplasia. PMID:18038007

  8. Total hip arthroplasty for osteoarthritis secondary to hip sequelae of pyogenic infection%全髋置换术治疗化脓性髋关节炎后遗畸形继发骨关节炎

    章军辉; 徐荣明; 凌晶; 刘华; 陶昆; 曾智敏; 章云峰; 何志勇; 狄正林; 冯建翔

    2012-01-01

    Objective To discuss the surgery complications and short-term effectiveness of total hip arthroplasty (THA) for osteoarthritis secondary to hip sequelae of pyogenic infection. Methods From 2004 to 2010, THA was carried out on 20 cases with osteoarthritis secondary to hip sequelae of pyogenic infection in our division. Eight cases were male and 12 cases were female. The average age was 48. 5 years. The average age of infection was 10. 2 years. The interval between active infection and arthroplasty was 34. 5 years. The average follow-up period was 3. 8 years. The direct lateral approach ( Hardinge's approach) was applied in 10 cases and posterolateral approach in the other 10 cases. According to X-ray the acetabular and femoral deformities were classified by Kim's classification system and the implant stability and peri-prosthetic osteolysis were evaluated. The clinical effect was measured with Harris hip scoring system pre-operatively and post-operatively. The heterotopic ossification was judged by Brooker method. Results According to Kim's classification, nine cases (45% ) were type Ⅰ , four cases (20% ) were type Ⅱ and seven cases (35% ) were type Ⅲ. Femoral fracture occurred in three cases intra-operatively and sciatic nerve palsy occurred in one patient with 4cm leg lengthening post-operatively. No hip dislocation, deep vein thrombosis or infection occurred. From X-ray view, no acetabular implant displacement ( > 2 mm) or abduction angle change was tested. The cyst formation ( > 2 mm) in the acetabular side occurred in two cases, which indicated osteolysis. The stem subsidence beyond 2.5 mm occurred in two cases. The cyst formation ( > 2 mm) in Gruen 2 area of the femoral stem occurred in one case. All cases abone had no clinical appearance and were closely observed. The average Harris hip score pre-operatively and post-operatively were 46. 8 and 88. 5 respectively, which was statistically significantly different (t = 12.32, P <0. 01). According to Brooker

  9. Cemented total hip prosthesis: Radiographic and scintigraphic evaluation

    Conventional radiographs, technetium-99m bone scans, and gallium-67 scans were reviewed in 44 patients who had undergone cemented total hip joint replacement and were imaged because of suspicion of prosthesis loosening or infection. A complete radiolucent line of 2 mm or wider along the bone-cement interface or metal-cement lucency on conventional radiographs was used as the criterion for prosthetic loosening with or without infection and proved to be 54% sensitive and 96% specific. Scintigraphic criteria for prosthetic loosening were increased focal uptake of the radiopharmaceutical for the femoral component and increased focal or diffuse uptake for the acetabular component. For bone scintigraphy, sensitivity was 73% and specificity was 96%. Combining the results of conventional radiographs and bone scans increased sensitivity to 84% and decreased specificity to 92% for the diagnosis of loosening, infection, or both. The study also showed that Ga-67 scintigraphy has a low sensitivity for the detection of infection

  10. Stereographic processing of CT figures in the hip joints

    Tomihara, Mitsuo (Kinki Univ., Osakasayama, Osaka (Japan). School of Medicine)

    1990-12-01

    CT scan is widely used in orthopedic examinations. By three-dimentional display of the form of bone and joint, the change of form can be identified and the lesion can be located. CT figures were stereographically processed using a personal computer to display the images of the hip joints. The outlines of the bone seen on the CT film were directly traced with a digitizer, then the A/D converted coordinate data were obtained. The data for each slice were input to the personal computer. After conversion to normal coordinate and magnification, the data were filed on the floppy disc. These data were regained from the disk and made affin transformation to display the stereographic images of the hip joints. In a case of solitary bone cyst of the coxal bone, this method helped us to decide the appropriated surgical approach. For the congenital dysplasia of the hip, acetabular coverage was examined three-dimensionally and postoperative changes were assessed in the cases of shelf operation and intertrochanteric extension osteotomy. In the cases of aseptic necrosis of the femoral head, location and size of the necrotic area were clearly visualized and the appropriate surgical procedure could be decided. Moreover, it was useful to decide the degree of rotation of the femoral head in rotational osteotomy. (author) 61 refs.

  11. Roles of Sagittal Anatomical Parameters of the Pelvis in Primary Total Hip Replacement for Patients with Ankylosing Spondylitis.

    Gu, Minghui; Zhang, Zhiqi; Kang, Yan; Sheng, Puyi; Yang, Zibo; Zhang, Ziji; Liao, Weiming

    2015-12-01

    We examined the correlation between acetabular prostheses and sagittal anatomical parameters of the pelvis for the preoperative evaluation of total hip arthroplasty in 29 patients with ankylosing spondylitis between April 2004 and November 2011. No implant dislocation or subsidence was observed at 4.18 years. The relationship between sagittal parameters conformed to the equation Pelvic incidence (PI)=Pelvic tilt (PT)+Sacral slope (SS). Better outcomes were achieved in the SS>PT group, postoperative function was positively correlated with SS/PI. Functional abduction and anteversion were positively correlated with PT but negatively correlated with SS. Due to the compensatory changes in the pelvis and spine of patients with AS, the preoperative assessment of sagittal parameters plays pivotal roles in placing acetabular prostheses in optimal positions and preventing postoperative impingement and dislocation. PMID:26164560

  12. 髋关节发育不良人工全髋关节置换术中髋臼中心重建%RECONSTRUCTION OF HIP CENTER IN TOTAL HIP ARTHROPLASTY FOR DEVELOPMENTAL DYSPLASIA OF HIP

    李雄峰; 管国华; 李建有

    2012-01-01

    ). The lower limbs were lengthened by 0,5-5.8 cm (mean, 2,5 cm). The Harris score was 87.7 ± 5,9 at 1 year after operation, showing significant difference when compared with preoperative score (t=21.77, P=0.00). X-ray films showed loosening of acetabular component in 1 case (1 hip) and displacement of acetabular component with too large abduction angle in 1 case (1 hip); no loosening and subsidence of acetabular or femoral components occurred in the other patients during follow-up. The horizontal location of hip center, the vertical distance between teardrop and the hip center, the vertical acetabular abduction angle, and the femoral offset were better than those before operation (P < 0,05). Conclusion For DDH patients, reconstructing the hip center in THA can lengthen the limb, improve the joint function, and reduce the failure rate of joint replacement.

  13. Press fit shape femoral heads for acetabular reconstruction - 5 to 8 years results

    Filling of acetabular defects with allograft bone is a favourable method in revision-THR provided that primary stability and load bearing capability can be achieved. Since 1990 we perform structural allografting in the acetabular area using a special technique. Defects are prepared with hemispherical reamers (male) in order to obtain a smooth concave surface. Deep-frozen femoral heads are then prepared using female shapers of a diameter 0-4mm larger, thus obtaining a convex surface fitting precisely into the prepared bed. In ideal cases a press-fit can be obtained granting primary stability without additional implants, otherwise we secure the grafts against rotation with one or two traction screws in loading-direction. Implantation of the cup is performed like in primary THR, care is taken to place the implant exactly at the anatomically correct position. Weight bearing is performed as soon as after primary THR; due to the technique loads are distributed evenly over the entire contact area to host bone, pressing the graft firmly into its bed. From 1990 to 1993 this method has been used in 179 cases. 104 cases could be followed between 60 and 95 months (average 71,5 months). Mean age at operation was 66,5 years (39-87 vears). Defects were classified according to Gross as cavitary in 15, minor column in 50 and major column in 39 cases. 85x the cup has been cemented, 19x cementless. One uncemented and 7 cemented cups loosened, all within the first 2 years. 6 meanwhile have been revised a second time. Those usually were cases, where the cup was placed in a non-anatomical position and / or the graft was not secured against rotatory forces. In 17 cases we observed slight condensation of the grafts with consequent migration of the implants. Migration usually did not exceed 5mm and no other signs of implant loosening have been associated. Radiographs indicated a unifon-n pattern of rapid graft-incorporation. Remodelling seemed to be completed after the second year, from

  14. Restauração do centro de rotação na artroplastia total do quadril minimamente invasiva Restoration of the rotation center in minimally-invasive total hip replacement

    José Ricardo Negreiros Vicente

    2009-01-01

    center as well as a good positioning of the acetabular component when using the minimally-invasive posterior approach for uncemented total hip replacement. METHODS: In a comparative non-random prospective study, 64 adult patients underwent elective total hip arthroplasty using the minimally-invasive posterior approach performed by one single surgeon. All patients included in this study had a superior and lateral migration of the rotation center of the hip in comparison to the normal contralateral hip. Patients were excluded from the study if they presented the following: diagnosis of femoral neck fracture, displasic hip types 2, 3 and 4 (Crowe's classification, osteoarthritis of the contralateral hip. Of the 64 patients in the study, 39 had a radiographic pre-op acetabular size planning equal or less than 50 mm and 25 patients had a radiographic pre-op acetabular size planning equal or more than 52 mm. We considered a good result the following goals: acetabular bend between 35 and 50 degrees, acetabular size according to the pre-op estimative with full contact in the three zones of DeLee-Charnley , a lower medial and vertical positioning of the rotation center in comparison with the pre-op values and a final limb discrepancy lower than 10 mm. RESULTS: A better restoration of the rotation center, as well as, excellent acetabular positioning was found in patients with smaller acetabular size (equal or less than 50, p=0, 04. We must draw attention to two risks when using the minimally-invasive posterior approach: a vertical acetabular position and a lateral position of the acetabular component increasing the risk of a poor contact in the zone 1 due to an insufficient reaming of the medial acetabular host bone. CONCLUSION: We propose standard surgical approaches in patients with larger anatomical measurements (acetabular planning size more than 50.

  15. "In vivo" determination of hip joint separation and the forces generated due to impact loading conditions.

    Dennis, D A; Komistek, R D; Northcut, E J; Ochoa, J A; Ritchie, A

    2001-05-01

    Numerous supporting structures assist in the retention of the femoral head within the acetabulum of the normal hip joint including the capsule, labrum, and ligament of the femoral head (LHF). During total hip arthroplasty (THA), the LHF is often disrupted or degenerative and is surgically removed. In addition, a portion of the remaining supporting structures is transected or resected to facilitate surgical exposure. The present study analyzes the effects of LHF absence and surgical dissection in THA patients. Twenty subjects (5 normal hip joints, 10 nonconstrained THA, and 5 constrained THA) were evaluated using fluoroscopy while performing active hip abduction. All THA subjects were considered clinically successful. Fluoroscopic videos of the normal hips were analyzed using digitization, while those with THA were assessed using a computerized interactive model-fitting technique. The distance between the femoral head and acetabulum was measured to determine if femoral head separation occurred. Error analysis revealed measurements to be accurate within 0.75mm. No separation was observed in normal hips or those subjects implanted with constrained THA, while all 10 (100%) with unconstrained THA demonstrated femoral head separation, averaging 3.3mm (range 1.9-5.2mm). This study has shown that separation of the prosthetic femoral head from the acetabular component can occur. The normal hip joint has surrounding capsuloligamentous structures and a ligament attaching the femoral head to the acetabulum. We hypothesize that these soft tissue supports create a passive, resistant force at the hip, preventing femoral head separation. The absence of these supporting structures after THA may allow increased hip joint forces, which may play a role in premature polyethylene wear or prosthetic loosening. PMID:11311703

  16. 经髂腹股沟和Kocher-Langenbeck联合入路治疗复杂移位髋臼骨折%Treatment of complex acetabular fractures with combined ilio-inguinal and Kocher-Langenbeck approach

    连鸿凯; 李兴华; 王爱国; 白玉

    2011-01-01

    Objective To investigate the clinical effect and treatment experience of complicated acetabular fractures treated with open reduction with combined ilio-inguinal and Kocher-Langenbeck (K-L) approaches.Methods Sixty-six patients with complicated acetabular fractures were treated surgically with combined ilio-inguinal and K-L approaches from February 2004 to December 2009.Among them,45 cases were followed up for 8-45 months,with the average 26 months.Results Operation time was 1.4-5.7 h,with the average of 2.8 h.Intraoperative blood loss was 530-2300 ml,with the average of 1250 ml.According to Matta's score system,the excellent and good rate was 86.7%.According to modified Merle d' Aubigne and Postel score system,the excellent and good rate of function of hip was 86.7%.According to Brooker heterotopic ossification standard assessment system:Ⅰ degrees in 6,Ⅱ degrees in 3.According to Letournel and Judet clinical classification system,postoperative traumatic arthritis were 6 patients.Among them,3 patients with Ⅲ- Ⅴ period with symptoms of serious hip pain and joint activities obstacles were treated with total hip replacement secondly.Six cases of sciatic nerve injury and 9 cases of lateral femoral cutaneous nerve damage were recovered gradually after six months to a year.All incisions healed primarily.All got bony union,the healing time was 8 to 16 weeks,with the average of 10.4 weeks.None was complicated with femoral head necrosis.Conclusion For the patients with complicated acetabular fractures,open reduction with combined ilio-inguinal and K-L approaches can get clinical advantages of revealed fully,fracture restoration convenient,fixed tightly,fewer complications and satisfactory result.%目的 探讨采用经髂腹股沟和Kocher-Langenbeck(K-L)联合入路行切开复位内固定治疗复杂移位髋臼骨折的疗效.方法2004年2月至2009年12月,采用经髂腹股沟和K-L联合入路治疗66例复杂移位髋臼骨折,对其中获得随访的45

  17. The other hip in unilateral hip dysplasia

    Jacobsen, Steffen; Rømer, Lone; Søballe, Kjeld

    2006-01-01

    We reviewed transverse pelvic computed tomography scans of 197 consecutively referred adult patients with hip pain thought to be secondary to developmental dysplasia. A center-edge angle of 20 degrees or less was considered the upper normal value. Four groups were identified: 69 patients...... with apparently unilateral right developmental dysplasia (left hip center-edge angles greater than 20 degrees), 26 patients with apparently unilateral left developmental dysplasia (right hip center-edge angles greater than 20 degrees), 68 patients with bilateral developmental dysplasia, and 34 patients...... with bilateral borderline developmental dysplasia (bilateral center-edge angles less than or equal to 25 degrees). The pelvic computed tomography scans were compared with computed tomography scans of 41 control subjects with healthy hips. The joint anatomy of patients with developmental dysplasia differed from...

  18. 髋臼横行骨折采用前后柱拉力螺钉结合重建钢板固定疗效分析%Analysis of the Effect of the Acetabular Transverse Fracture Using the Lag Screw of the Acetabulum and the Reconstruction Plate With the Reconstruction Plate

    张立峰; 冯卫; 包道日娜; 冬梅; 佟雁翔

    2015-01-01

    Objective To investigate the clinical effect of the application of the acetabular transverse fracture in the treatment of the acetabular fracture and the reconstruction of the plate fixation with the lag screw of the acetabulum. Methods 50 cases of patients with transverse acetabular fracture were selected,and subject to acetabular posterior column lag screw combined with reconstruction plate fixation treatment,Bleeding volume,operation time, the acetabulum repositioning and hip joint function recovery after surgical of patients were observed. Results The average operation time was 3.5 hours, the average amount of bleeding was 950ml, according to Matta reduction, 25 cases of anatomic reduction, satisfactory reduction in 21 cases, 4 cases of unsatisfactory reduction, and the excellent and good rate of hip joint function was 86.0%. Conclusion The clinical effect of the acetabular transverse fracture patients with the acetabular anterior and posterior column lag screw combined with the reconstruction plate fixation is worthy of promotion.%目的:探讨对髋臼横行骨折患者应用髋臼前后柱拉力螺钉结合重建钢板固定治疗的临床疗效。方法选取髋臼横行骨折患者50例,对其进行髋臼前后柱拉力螺钉结合重建钢板固定手术治疗,观察患者手术时出血量、手术时间等,手术治疗后患者髋臼复位情况以及髋关节功能恢复情况。结果平均手术时间为3.5小时,平均出血量为950 ml,根据 matta 复位,25例解剖复位,21例满意复位,4例复位不满意,髋关节功能优良率为86.0%。结论对髋臼横行骨折患者采取髋臼前后柱拉力螺钉结合重建钢板固定手术治疗临床疗效突出。

  19. “钢筋混凝土”在髋臼重建中的应用★%Application of “reinforced concrete” in acetabular reconstruction

    王子富; 尚希福

    2013-01-01

      背景:在全髋关节置换中,髋臼缺损很常见,为重建一个稳定、牢固的髋臼,置换过程中往往需要髋臼的重建。目的:探讨螺钉固定钛网结合骨水泥型髋臼杯在髋臼重建中应用的早期疗效。方法:纳入采用螺钉固定钛网结合骨水泥型臼杯重建髋臼髋关节翻修的患者23例。疼痛病史1-3年,术前 Harris 评分20-48分,平均34分。重建后采用 X 射线平片评价髋臼假体松动标准进行影像学评价及 Harris 评分定期随访。结果与结论:重建后随访1-3年,平均随访24个月,无脱失。重建后3个月 Harris 评分较重建前显著增高,置换后2年髋关节活动度较置换前显著增高,差异均有显著性意义(P <0.05)。2例患者下肢不等长,1例患者下蹲后出现脱位,保守治疗后好转。最后一次随访时无早期感染、脱位,无盆腔不适感。重建后随访影像学上显示无髋臼假体松动与移位,未发生钛网断裂。说明螺钉固定钛网结合骨水泥型髋臼杯治疗65岁以上髋关节翻修患者其近期疗效十分满意,后期疗效还有待于进一步随访观察。%BACKGROUND: In total hip arthroplasty, acetabular defects are common, for the reconstruction of a stable and solid acetabulum, the acetabular reconstruction is often required during the replacement process.OBJECTIVE: To investigate the early effect of the short term results of titanium mesh fixed by screws combined with a cemented acetabular cup in acetabular reconstruction. METHODS: Twenty-three patients treated with acetabular reconstruction by screw fixed titanium mesh combined with a cemented acetabular cup were selected. The pain history was 1 to 3 years. Harris scores before operation were 20-48 with an average score of 34. X-ray plain film was used to evaluate theacetabular prosthesis loosening standards after reconstruction for the radiographic evaluation and Harris score of regular fol ow

  20. Hip Revision

    Full Text Available ... and we're going to be having live operative techniques of the ZMR Tapered System performed by Dr. Scott Sporer. We're going to initially look at Scott's preoperative x-rays ...

  1. Painful Hip Prosthesis: Definition

    Ferrata, P.; Carta, S.; Fortina, M.; Scipio, D.; Riva, A.; Di Giacinto, S.

    2010-01-01

    Pain is the main reason inducing patients to undergo surgery and persistence of pain after the operation is a major concern, both for the patient and the surgeon. Up to 10% of patients report pain five years after hip arthroplasty. An analysis of the literature reveals numerous causes of pain localised to the replacement hip. In assessing a painful hip it is fundamental to arrive at a definite diagnosis before starting any treatment. Intrinsic causes can be identified, such as unrecognised as...

  2. Imaging of hip arthroplasty

    Miller, Theodore T., E-mail: millertt@hss.edu [Department of Radiology and Imaging, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 (United States)

    2012-12-15

    The imaging evaluation of the prosthetic hip begins with radiography, but arthrography, aspiration, scintigraphy, sonography, CT and MR imaging all have roles in the evaluation of the painful prosthesis. This article will review the appearance of normal hip arthroplasty including hemiarthroplasty, total arthroplasty, and hip resurfacing, as well as the appearances of potential complications such as aseptic loosening and osteolysis, dislocation, infection, periprosthetic fracture, hardware failure, and soft tissue abnormalities.

  3. Hip fracture - discharge

    Inter-trochanteric fracture repair - discharge; Subtrochanteric fracture repair - discharge; Femoral neck fracture repair - discharge; Trochanteric fracture repair - discharge; Hip pinning surgery - discharge

  4. Technical innovation: digital tomosynthesis of the hip following intra-articular administration of contrast

    To demonstrate the clinical use of digital tomosynthesis in the depiction of labral and chondral pathology in the setting of post-operative CAM-type impingement of the hip following intra-articular administration of dilute iodinated contrast. We present images from a 46 year-old African American female with suspected CAM-type femoroacetabular impingement (FAI) following percutaneous pinning of the right hip for slipped capital femoral epiphysis (SCFE). A partial tear of the labrum and clinically significant acetabular chondral abnormalities were demonstrated with the use of digital tomosynthesis with superb anatomic detail. Digital tomosynthesis can be of great clinical utility and can depict pathology in superb anatomic detail, particularly in situations in which MRI is not available as well as under circumstances in which artifact due to orthopedic hardware is of concern as shown in this case. (orig.)

  5. Wear tests in a hip joint simulator of different CoCrMo counterfaces on UHMWPE

    The objective in this work was to study the effect of different material counterfaces on the Ultra High Molecular Weight Polyethylene (UHMWPE) wear behavior. The materials used as counterfaces were based on CoCrMo: forged with hand polished and mass finished, CoCrMo coating applied on the forged CoCrMo alloy obtained by Physical Vapour Deposition (PVD). A hip joint simulator was designed and built for these studies. The worn surfaces were observed by optical and scanning electron microscopy. The results showed that the hand polished CoCrMo alloy caused the higher UHMWPE wear of the acetabular cups. The CoCrMo coating caused the least UHMWPE wear, while the mass finished CoCrMo alloy caused an intermediate UHMWPE wear. It is shown that the wear rates obtained in this work are closer to clinical studies than to similar hip joints simulator studies

  6. Technical innovation: digital tomosynthesis of the hip following intra-articular administration of contrast

    Gazaille, Roland E.; Flynn, Michael J.; Page, Walter; Finley, Sonia; Holsbeeck, Marnix van [Henry Ford Hospital, Department of Musculoskeletal Radiology, Detroit, MI (United States)

    2011-11-15

    To demonstrate the clinical use of digital tomosynthesis in the depiction of labral and chondral pathology in the setting of post-operative CAM-type impingement of the hip following intra-articular administration of dilute iodinated contrast. We present images from a 46 year-old African American female with suspected CAM-type femoroacetabular impingement (FAI) following percutaneous pinning of the right hip for slipped capital femoral epiphysis (SCFE). A partial tear of the labrum and clinically significant acetabular chondral abnormalities were demonstrated with the use of digital tomosynthesis with superb anatomic detail. Digital tomosynthesis can be of great clinical utility and can depict pathology in superb anatomic detail, particularly in situations in which MRI is not available as well as under circumstances in which artifact due to orthopedic hardware is of concern as shown in this case. (orig.)

  7. Dislocation of primary total hip arthroplasty and the risk of redislocation.

    Brennan, Stephen A

    2012-09-01

    6554 primary total hip arthroplasties were reviewed. Risk factors for dislocation were analysed to assess which were important in terms of predicting recurrent instability. The patients risk of having a second dislocation was independently associated with the surgical approach adopted (p = 0.03) and the time to first dislocation from the primary hip replacement (p = 0.002). Early dislocators whose surgery was performed through an anterolateral approach had less recurrence than late dislocators through a posterior or transtrochanteric approach. None of the other risk factors including head size (p = 0.59), modularity (p = 0.54), mechanism of dislocation (p = 0.23), leg length discrepancy (p = 0.69) and acetabular inclination (p = 0.31) were influential. The use of an abduction brace was not useful in preventing a further dislocation with 69.2% of those braced re-dislocating compared to 68.5% who were not braced (p = 0.96).

  8. Outcome of surgical management of developmental dysplasia of hip in children between 18 and 24 months

    Narasimhan Ramani

    2014-01-01

    Materials and Methods: 35 children with unilateral DDH were operated between 2002 and 2007 at our institute. Open reduction was performed in all using the standard anterior approach and peroperative test for hip stability was done. Nine children got an additional pelvic procedure in the form of Dega acetabuloplasty. All were followed up for a minimal period of 2 years (range 2-7 years. Results: No hip got redislocated. At the end of 18 months, there were seven cases of RAD with acetabular index (AI of 35° and above. These were all from the group where open reduction alone was done. Conclusion: We feel that a preoperative AI of >40° and a per-operative safe-zone <20° increases the need for supplementary pelvic osteotomy in age group of 18 to 24 months because in such cases, the remodeling capacity of the acetabulum is unable to overcome the dysplasia and to form a relatively normal acetabulum.

  9. Quantitative evaluation of hip joint laxity in 22 Border Collies using computed tomography

    The purpose of this study was to obtain the computed tomography (CT) data for the hip joints of 22 Border Collies. The dorsolateral subluxation (DLS) score, lateral center edge angle (LCEA), dorsal acetabular rim angle (DARA) and center distance (CD) index were measured on the CT images in a weight-bearing position. Radiographic Norberg angle (NA) was also measured. The mean values were 45.7+-10.2% for DLS score, 85.9deg+-10.3deg for LCEA, 18.5deg+-7.3deg for DARA, 0.40+-0.17 for CD index and 102.7deg+-6.9deg for NA. Since the DLS score and LCEA showed strong correlation, combined use of these parameters might improve diagnostic accuracy. We consider CT evaluation in a weight-bearing position to be a useful method for multidirectional evaluation of hips

  10. Hip Fractures among Older Adults

    ... online training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet ... get older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking ...

  11. 14-3-3/HIP-55 complex increases the stability of HIP-55%14-3-3/HIP-55复合体增强HIP-55蛋白稳定性

    田爱炬; 李子健

    2015-01-01

    目的:用双分子荧光互补及免疫共沉淀技术验证HIP-55与14-3-3在HEK293细胞中存在相互作用,并进一步研究其生物学意义. 方法:利用GATEWAY系统构建PDEST-N-Venus-HIP-55WT(野生型),PDEST-N-Venus-HIP-55AA(突变体S269A/T291A),PDEST-GST-HIP-55WT及PDEST-C-Venus-14-3-3τ重组质粒,利用双分子荧光互补及免疫共沉淀技术检测两者的相互作用,同时应用14-3-3蛋白相互作用抑制肽R18和HIP-55蛋白突变体( HIP-55AA突变体S269A/T291A不能与14-3-3相互作用)作为工具研究两者结合后对嘌呤霉素诱导的HIP-55蛋白表达的影响. 结果:外源转入的Venus-HIP-55WT、Venus-HIP-55AA及Venus-14-3-3蛋白能够在HEK293细胞中表达;双分子荧光互补实验结果表明HIP-55与14-3-3存在相互作用,HIP-55蛋白的S269/T291位点介导HIP-55与14-3-3的相互作用;免疫共沉淀技术表明内源性HIP-55与14-3-3存在相互作用;进一步研究发现HIP-55与14-3-3复合体增强HIP-55蛋白的稳定性,保护HIP-55不被降解. 结论:14-3-3与HIP-55存在相互作用,14-3-3/HIP-55复合体可以促进HIP-55蛋白的稳定性.%Objective:To further demonstrate the interaction of a new 14-3-3 interaction protein hema-topoietic progenitor kinase 1 [ HPK1 ]-interacting protein ( HIP-55 ) and 14-3-3 proteins and its potential biological function in HEK293 cells. Methods:PDEST-N-Venus-HIP-55WT (wild type),PDEST-N-Ve-nus-HIP-55AA (mutants, S269A/T291A, abolishing the binding of HIP-55 to 14-3-3),PDEST-GST-HIP-55WT and PDEST-C-Venus-14-3-3τplasmids were constructed by gateway system. Their expressions were demonstrated by Western blotting method. Then we used Bimolecular Fluorescence Complementation ( BiFC) and co-immunoprecipitation ( co-IP) methods to demonstrate the interaction of HIP-55 and 14-3-3 in HEK293 cells. Moreover, the 14-3-3 antagonist peptide, R18 and HIP-55 protein mutant plasmid HIP-55 AA were used to detect the protein synthesis of HIP-55 at different time points

  12. The fate of the hip in spondylo-epi-metaphyseal dysplasia: clinical and radiological evaluation of adults with SEMD Handigodu type

    Siddesh, N.D.; Shah, Hitesh; Joseph, Benjamin [Kasturba Medical College, Paediatric Orthopaedic Service, Manipal, Karnataka State (India)

    2012-08-15

    This study was undertaken to document the fate of the hip with reference to its structure and function in patients with spondylo-epi-metaphyseal dysplasia tarda Handigodu type (SEMD{sub HG}). Radiographs of 271 adult patients with SEMD{sub HG} were studied to identify the pattern of long-term sequelae in the hips. Several measurements of the proximal femur and acetabulum were made to quantify morphological alterations in the hip. Fifty-four adult patients were examined and administered a questionnaire to evaluate the extent of disability attributable to the hips. Three patterns of changes in the hips were noted: 35% had acetabular protrusio, 33% had subluxation of the hip, and 32% had no protrusio or subluxation. Distinctly different anthropometric measurements and dimensional alterations around the hip were noted in these three patterns. Patients with protrusio were relatively tall while those with subluxation were the shortest. All the patients had developed degenerative arthritis of the hips by the fourth decade of life irrespective of the pattern of hip involvement. The reduction in the range of hip motion and fixed deformities were most severe in patients with protrusio. All the patients had significant disability and very low functional hip scores. Degenerative arthritis of the hip develops in the majority of patients with SEMD{sub HG}; the symptoms are severe enough to warrant reconstructive surgery by the fourth decade of life. Protrusio or subluxation develops in a third of the patients each; both these complications will influence the surgical approach if total hip arthroplasty is planned. (orig.)

  13. Formation of a pseudotumor in total hip arthroplasty using a tribological metal–polyethylene pair☆

    Fagotti, Lorenzo; Vicente, José Ricardo Negreiros; Miyahara, Helder Souza; de Oliveira, Pedro Vitoriano; Bernabé, Antônio Carlos; Croci, Alberto Tesconi

    2015-01-01

    The aim here was to report a case of a young adult patient who evolved with tumor formation in the left thigh, 14 years after revision surgery on hip arthroplasty. Davies in 2005 made the first description of this disease in patients undergoing metal-on-metal hip arthroplasty. Over the last decade, however, pseudotumors around metal-on-polyethylene surfaces have become more prevalent. Our patient presented with increased volume of the left thigh 8 years after hip arthroplasty revision surgery. Two years before the arising of the tumor in the thigh, a nodule in the inguinal region was investigated to rule out a malignant neoplastic process, but the results were inconclusive. The main preoperative complaints were pain, functional limitation and marked reduction in the range of motion of the left hip. Plain radiographs showed loosening of acetabular and femoral, and a large mass between the muscle planes was revealed through magnetic resonance imaging of the left thigh. The surgical procedure consisted of resection of the lesion and removal of the components through lateral approach. In respect of total hip arthroplasty, pseudotumors are benign neoplasms in which the bearing surface consists of metal-on-metal, but they can also occur in different tribological pairs, as presented in this case.

  14. Femoral and obturator nerves palsy caused by pelvic cement extrusion after hip arthroplasty.

    Pawel Zwolak

    2011-05-01

    Full Text Available Cement extrusion into the pelvis with subsequent palsy of the obturator and femoral nerves is a rare entity after hip replacement surgery. Cemented fixation of the acetabular cup has been considered as a safe and reliable standard procedure with very good long term results. We present a case of fifty year old female patient after hip arthroplasty procedure which suffered an obturator and femoral nerve palsy caused by extrusion of bone cement into the pelvis. Postoperative X-rays and CT-scan of the pelvis demonstrated a huge mass consisted of bone cement in close proximity of femoral and obturator nerves. The surgery charts reported shallow and weak bony substance in postero-superior aspect of the acetabulum. This weak bony acetabular substance may have caused extrusion of bone cement during press-fitting of the polyethylene cup into the acetabulum, and the following damage of the both nerves produced by polymerization of bone cement. The bone cement fragment has been surgically removed 3 weeks after arthroplasty. The female patient underwent intensive postoperative physical therapy and electro stimulation which resulted in full recovery of the patient to daily routine and almost normal electromyography results.

  15. The geometry of the bone structure associated with total hip arthroplasty.

    Zhang Yang

    Full Text Available Close adaptation of the prosthesis to the bone is the key to achieving optimal stability and fixation for total hip arthroplasty (THA. However, there have been no adequate studies of bone morphology, especially in different races. The aim of this study was to analyze the geometry of the acetabulum and proximal femur of people from South China, based on three-dimensional reconstruction, and to detect differences between different population subsets. CT scans were performed on 80 healthy volunteers (160 hips from South China, comprising 40 males (80 hips and 40 females (80 hips. The images were imported into Mimics 10.01 to perform 3D reconstruction. THA-associated anatomical parameters were measured and compared with other published data. In comparison with published data, it seemed that people from South China have smaller acetabular abduction angle, larger acetabular supro-inferior diameter, larger neck-shaft angle, smaller offset, thinner femoral shaft and more proximal isthmus, which needed to be further confirmed. There were significant differences between the genders in most parameters. As significant differences in canal flare index (CFI and distal canal flare index (DCFI were found between genders, it was concluded the most significant differences lay in the isthmus of the femur. Among the femora, according to Noble's classification we identified more normal types and fewer stovepipe and champagne-flute types than expected from the literature, indicating that uncemented prostheses would be suitable for most people from South China. Our findings reveal that simply choosing the smallest of a series of prostheses would not necessarily provide a good fit, due to the different trends from the proximal to the distal part of the femur. Significant variation exists in THA-associated anatomy between genders and population subsets. It is therefore imperative that each patient receives individual consideration rather than assuming all patients have

  16. Minimum ten-year follow-up of acetabular fracture fixation from the Irish tertiary referral centre.

    Magill, Paul

    2012-04-01

    Successful outcome from acetabular fracture fixation is multi-factorial. Long-term results are not frequently reported. Pooling such data from high output centres will help progress acetabular fixation. This paper presents the first ten-year data from the Irish tertiary referral centre.

  17. Hip Implant Systems

    ... Archive Combination Products Advisory Committees Regulatory Information Safety Emergency Preparedness International Programs News & Events Training & Continuing Education Inspections & Compliance Federal, State & Local Officials Consumers Health Professionals Science & Research Industry Scroll back to top ...

  18. Abordagem cirúrgica inédita para denervação acetabular em cães A new surgical approach to acetabular denervation in dogs

    Cássio R.A. Ferrigno

    2007-02-01

    Full Text Available Este artigo tem por objetivo demonstrar nova abordagem cirúrgica para denervação seletiva das fibras sensitivas do periósteo acetabular, para tratamento da displasia coxo femoral em cães, conduzidas em 189 articulações. Para tanto, é descrita abordagem da região cranial e dorso-lateral do acetábulo de cães por incisão em forma de meia lua de aproximadamente de três centímetros de extensão, iniciando trocânter maior do fêmur e em direção ao corpo do ílio. Após rebatimento dorsal do músculo glúteo médio, secciona-se parcialmente a inserção do m. glúteo profundo para acesso às regiões citadas. Com auxílio de cureta foi removido, em todos os pacientes, periósteo na margem acetabular cranial e dorso lateral, até a exposição da cortical óssea. Em todos os animais foi possível a abordagem, tanto da face cranial como também acesso para a curetagem da face dorsal do acetábulo, com a técnica descrita, com incisão de pele de aproximadamente 3,2cm. A curetagem da porção cranial do acetábulo foi, em todos os casos realizados, sem visualização do osso, mas de fácil confecção e sem intercorrências de lesão de nervos ou músculos. Em todas as abordagens foi possível visualizar a cápsula articular da articulação coxo femoral, e em nenhum dos animais esta estrutura foi incisada por erro de técnica. Conclui-se que a abordagem cirúrgica descrita no presente trabalho é factível para este tipo de procedimento cirúrgico em cães, promovendo acesso adequado, com mínima invasão e sem complicações de qualquer natureza.The purpose of this study is to demonstrate a new surgical approach for the selective denervation of the sensitive fibers of the acetabular periosteum, for the treatment of hip dysplasia in dogs, conducted in 189 joints.The surgical approach of the cranial and dorso-lateral regions of the acetabular joint in dogs, by moon-shaped incision of approximately 3cm in extension, starting from the

  19. Hip Problems in Infants

    ... problems that can lead to dislocation of the hip bones. This is also called dysplasia (say: "diss-play-see-uh"). This means that ... problems later in life? Source Screening for Developmental Dysplasia of the Hip by LM French, M.D., and FR Dietz, ...

  20. Hip joint injection

    ... cause of the pain. For some, it can last weeks or months. Alternative Names Cortisone shot - hip; Hip injection; Intra-articular steroid ... writing by ADAM Health Solutions. About MedlinePlus Site Map FAQs Contact ... Institutes of Health Page last updated: 23 August 2016

  1. MR imaging of the hip

    Full text: MRI has been shown to gain increasing importance in recent years in the evaluation of disorders of the hip and pelvis. Nowadays, conventional or fast spin echo (T1, Turbo (Fast) T2 (or PD)) MR imaging sequences are used most commonly to examine the hip and pelvis. Three dimensional (3D) gradient echo (GE) imaging allows acquisition of very thin (1 mm) sections. MR imaging with fat suppression technique (STIR, TIRM, FAT SAT T2) represent an effective screening technique for the assessment of fluid, hemorrhage, pus, or tumor in the marrow, joint or soft tissues. These techniques increase the sensitivity for the detection of a variety of pathologic processes. Fat suppression MR imaging, when combined with intravenous (or intraarticular) administration of a gadolinium compound, also is effective and often is employed when evaluating neoplastic or infectious diseases (intravenous injection), abnormalities of articular cartilage or labrum, or possible intraarticular osteocartilaginous bodies (intraarticular injection). A lesion of the acetabular labrum based is one cause of chronic hip pain in patients with developmental dysplasia of the hips, as well as in patients with a history of hip trauma or femoroacetabular impingement. MR imaging and, in particular, MR arthrography, however, have been shown to be highly accurate in the detection of subtle intraarticular abnormalities such as labral lesion. Conventional MR imaging has shown poor accuracy in detecting labral lesions, due to its inability to depict small tears and the difficulty in determining if intralabral signal abnormalities extend to the surface of the labrum. MR arthrography, however has been shown to overcome these difficulties and to have excellent accuracy in detecting labral pathology. As labral abnormalities are believed to be a precursor of osteoarthritis, orthopedic surgeons believe that surgical intervention will be influenced substantially by the type, extension and location of labral

  2. Hip Reconstruction Osteotomy by Ilizarov Method as a Salvage Option for Abnormal Hip Joints

    Masood Umer

    2014-01-01

    Full Text Available Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg’s gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD.

  3. Hip reconstruction osteotomy by Ilizarov method as a salvage option for abnormal hip joints.

    Umer, Masood; Rashid, Haroon; Umer, Hafiz Muhammad; Raza, Hasnain

    2014-01-01

    Hip joint instability can be secondary to congenital hip pathologies like developmental dysplasia (DDH) or acquired such as sequel of infective or neoplastic process. An unstable hip is usually associated with loss of bone from the proximal femur, proximal migration of the femur, lower-extremity length discrepancy, abnormal gait, and pain. In this case series of 37 patients coming to our institution between May 2005 and December 2011, we report our results in treatment of unstable hip joint by hip reconstruction osteotomy using the Ilizarov method and apparatus. This includes an acute valgus and extension osteotomy of the proximal femur combined with gradual varus and distraction (if required) for realignment and lengthening at a second, more distal, femoral osteotomy. 18 males and 19 females participated in the study. There were 17 patients with DDH, 12 with sequelae of septic arthritis, 2 with tuberculous arthritis, 4 with posttraumatic arthritis, and 2 with focal proximal femoral deficiency. Outcomes were evaluated by using Harris Hip Scoring system. At the mean follow-up of 37 months, Harris Hip Score had significantly improved in all patients. To conclude, illizarov hip reconstruction can successfully improve Trendelenburg's gait. It supports the pelvis and simultaneously restores knee alignment and corrects lower-extremity length discrepancy (LLD). PMID:24895616

  4. Total Hip Arthroplasty for Hip Fractures

    Monzón, Daniel Godoy; Iserson, Kenneth V.; Jauregui, José; Musso, Carlos; Piccaluga, Francisco; Buttaro, Martin

    2014-01-01

    Introduction: This study aimed to determine the dislocation and reoperation rate, functional outcomes, and the survival rate of the unique subset of very old but lucid and independent patients with hip fractures following a total hip arthroplasty (THA) and geriatric team-coordinated perioperative care. Method: Between 2000 and 2006, previously independent ambulatory patients ≥80 years old presenting with an intracapsular hip fracture were given THAs under the care of an integrated orthopedic surgery–geriatric service. Their fracture-related complications, ambulation, mental status, and survival were followed for 5 to 11 years postinjury. Results: Five years postinjury, 57 (61.3%) patients of the original study group were living. In all, 3 (3.2%) patients had postoperative hip dislocations (and 2 patients had dislocation twice) and 2 reoperations were needed within the first postoperative month. There were no hip dislocations or reoperations after the first year. Radiographs obtained on 88% of the surviving patients at 5 years postoperatively showed that all remained unchanged from their immediate postoperative images. Nearly half of the patients were still able to ambulate as they did preoperatively and their mixed-model equation was statistically unchanged. Conclusion: This study of patients >80 years old with previously good functional status demonstrates that with appropriate surgical (best prosthesis, good operating technique, and regional anesthesia) and geriatric (pre- and postoperative assessments, close follow-up, medication adjustments, and fall-prevention instruction) care, they have few hip dislocations and reoperations, survive postfracture at least as long as their noninjured contemporaries, and continue to function and ambulate as they did prior to their injury. PMID:24660092

  5. Formed HIP Can Processing

    Clarke, Kester Diederik [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-07-27

    The intent of this report is to document a procedure used at LANL for HIP bonding aluminum cladding to U-10Mo fuel foils using a formed HIP can for the Domestic Reactor Conversion program in the NNSA Office of Material, Management and Minimization, and provide some details that may not have been published elsewhere. The HIP process is based on the procedures that have been used to develop the formed HIP can process, including the baseline process developed at Idaho National Laboratory (INL). The HIP bonding cladding process development is summarized in the listed references. Further iterations with Babcock & Wilcox (B&W) to refine the process to meet production and facility requirements is expected.

  6. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P

    2015-04-01

    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components. PMID:24956572

  7. Achados em ressonância magnética artrográfica de indivíduos com lesão do labrum acetabular Magnetic resonance arthrographic findings in subjects with acetabular labral tears

    André Luiz Almeida Pizzolatti

    2011-01-01

    Full Text Available OBJETIVO: Descrever os achados em artro RM de sujeitos com suspeita de lesão do labrum acetabular. MÉTODO: Foram analisadas 108 artro RM de quadris em 2007/2008. Dois radiologistas independentemente analisaram as imagens e foi considerada a resposta comum entre eles. Com base em seus pareceres observou-se o local e estadiamento das lesões labrais e condrais, as alterações anatômicas, e a presença de tendinite e bursite trocantérica. RESULTADO: As lesões labrais grau I ocorreram em 41% dos casos, grau II em 31%, e grau III em 29%. O IFA tipo cam foi frequente em 36% dos casos, tipo pincer em 11%, e IFA misto em 13%, nestes casos 57% apresentaram lesão labral grau III, A lesão condral grau I foi observada em 51% acetábulos, as de grau II em 13%, e grau III em 18%. CONCLUSÃO: As alterações morfológicas que provocam IFA do tipo cam foram as mais prevalentes. Em relação ao grau de lesão labral e condral foram predominantes as lesões grau I independente da presença ou do tipo de IFA, exceto em IFAs mistos onde houve predomínio de lesão labral grau III. Não foi observada uma relação entre o grau de lesão labral e condral.OBJECTIVE: To describe the MR arthrographic findings in subjects with suspected acetabular labral tears of the hip. METHOD: 108 hip MRa results were analyzed in 2007-2008. Two radiologists independently interpreted the images, and the consensual answers between them were considered for analysis. Based on their opinions, information was obtained on the location, staging of the chondral and labral lesions, anatomic alterations, and the presence of trochanteric bursitis and tendonitis. RESULTS: 1st degree labral lesions occurred in 41% of cases, 2nd degree in 31%, and 3rd degree in 29%. The cam type FAI was common in 36% of cases, pincer FAI in 11%, and mixed cam-pincer FAI in 13%; in these cases 57% had grade III labral lesions. 1st degree chondral lesions were observed in 51% of acetabulum, 2nd degree in 13

  8. Isolated Polyethylene Exchange versus Acetabular Revision for Polyethylene Wear

    Restrepo, Camilo; Ghanem, Elie; Houssock, Carrie; Austin, Mathew; Parvizi, Javad; Hozack, William J.

    2008-01-01

    Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for...

  9. Direct costs of osteoporosis and hip fracture: An analysis for the Mexican Social Insurance Health Care System

    Fernando Carlos; Patricia Clark; Humberto Maciel; Juan A Tamayo

    2009-01-01

    Objective. To compare costs of diagnosis and annual treatment of osteoporosis and hip fracture between the Instituto Nacional de Rehabilitación (INR) and the protocol used by the Seguro Popular de Salud (SPSS). Methods. Direct costs gathered in a prospective study with real cases at the INR are presented, and then this data is re-analyzed with the methodology and protocol for the SPSS to estimate the costs of those cases if treated with the SPSS protocol. Results. Important differences were f...

  10. Pathogeny and natural history of congenital dislocation of the hip.

    Seringe, R; Bonnet, J-C; Katti, E

    2014-02-01

    Based on a review of the literature, the authors have made a critical study of several etiological factors. Endogenous factors such as acetabular dysplasia, increased anteversion of the femoral neck, and capsular laxity support the genetic theory but are neither constant nor necessary and are only facilitating factors. The major factor seems to be a mechanical one linked to the position in the uterus: hyperflexion with adduction and external rotation constituting the dislocating foetal posture combined with abnormal pressure on the greater trochanter and leading to expulsion of the head upward and backward. This theory can explain the natural history of C D H which is first, at birth a hip instability followed by two possible evolutions: either persistent luxation becoming irreducible or spontaneous stabilisation leading sometimes to complete healing or to residual abnormalities (subluxation or dysplasia). This concept suggests practical conclusions: the importance of an early diagnosis, the selection of the signs of the hip at risk, the pattern of prevention, the role for non-clinical investigations, the principles of the treatment based on postures, the indications for the different types of treatment. PMID:24456762

  11. Imaging of traumatic dislocation of the hip in childhood

    Vialle, Raphael; Pannier, Stephanie; Odent, Thierry; Glorion, Christophe [Necker Enfants-Malades Hospital, Department of Paediatric Orthopaedics, Paris Cedex 15 (France); Schmit, Pierre [Necker Enfants-Malades Hospital, Department of Paediatric Radiology, Paris (France); Pauthier, Francois [CHI Poissy Saint Germain en Laye, Department of Orthopaedic Surgery, Poissy (France)

    2004-12-01

    Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality. (orig.)

  12. Imaging of traumatic dislocation of the hip in childhood

    Traumatic hip dislocation in childhood is a rare consequence of violent trauma. After reduction, outcome is usually favourable although epiphyseal necrosis can occur. Reduction must be carried out as soon as possible and is achieved easily, although if the labrum is involved, surgery may be required to achieve complete reduction. To analyze a retrospective series of traumatic hip dislocations in children, describing the therapeutic and imaging strategy. A total of 42 patients were studied. Their mean age was 10 years 3 months. All relevant radiographic, CT, MRI and radionuclide bone scan examinations were reviewed. Special attention was paid to associated lesions. In 22 patients the dislocation was caused by low-energy trauma. Road traffic accidents accounted for 17 dislocations. An acetabular fracture was present in six patients and the femoral head was fractured in three. Reduction was easily achieved in 31 patients. In 11 patients the postreduction radiograph and CT showed joint space asymmetry secondary to labral entrapment. Only two patients developed epiphyseal necrosis. It has been difficult to define and evaluate accurate principles for a medical imaging strategy in this group of patients. Analysis of plain radiographs is essential before and after reduction of the joint, and it is important to perform postreduction CT in every patient whose joint space remains widened. A radionuclide bone scan should be performed between the second and third weeks after injury to assess epiphyseal vascularity. With the use of specific sequences, MRI may be an alternative modality to assess epiphyseal vitality. (orig.)

  13. Midterm results of 36 mm metal-on-metal total hip arthroplasty

    Hawar Akrawi

    2016-01-01

    Full Text Available Background: Despite the many perceived benefits of metal-on-metal (MoM articulation in total hip arthroplasty (THA, there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD. Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup. Materials and Methods: 288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS MRI was undertaken and implant cumulative survivorship was evaluated. Results: The mean followup was 5 years (range 2–7 years, mean age was 73 years and the mean Oxford hip score was 36.9 (range 5–48. Revision arthroplasty was executed in 20 (7.4% patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2% patients, infection in 5 (1.9% patients and aseptic loosening in 5 (1.9% patients. Three (1.1% patients had their hips revised for instability, 1 (0.3% for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years. Conclusions: Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the

  14. Accuracy and Precision of Three-Dimensional Low Dose CT Compared to Standard RSA in Acetabular Cups: An Experimental Study

    Olivecrona, Henrik; Maguire, Gerald Q.; Noz, Marilyn E.; Zeleznik, Michael P.

    2016-01-01

    Background and Purpose. The gold standard for detection of implant wear and migration is currently radiostereometry (RSA). The purpose of this study is to compare a three-dimensional computed tomography technique (3D CT) to standard RSA as an alternative technique for measuring migration of acetabular cups in total hip arthroplasty. Materials and Methods. With tantalum beads, we marked one cemented and one uncemented cup and mounted these on a similarly marked pelvic model. A comparison was made between 3D CT and standard RSA for measuring migration. Twelve repeated stereoradiographs and CT scans with double examinations in each position and gradual migration of the implants were made. Precision and accuracy of the 3D CT were calculated. Results. The accuracy of the 3D CT ranged between 0.07 and 0.32 mm for translations and 0.21 and 0.82° for rotation. The precision ranged between 0.01 and 0.09 mm for translations and 0.06 and 0.29° for rotations, respectively. For standard RSA, the precision ranged between 0.04 and 0.09 mm for translations and 0.08 and 0.32° for rotations, respectively. There was no significant difference in precision between 3D CT and standard RSA. The effective radiation dose of the 3D CT method, comparable to RSA, was estimated to be 0.33 mSv. Interpretation. Low dose 3D CT is a comparable method to standard RSA in an experimental setting. PMID:27478832

  15. Computerized tomography in evaluation of decreased acetabular and femoral anteversion; Besonderheiten bei der Bestimmung der Hueftpfannenanteversion und Schenkelhalsantetorsion durch Computertomographie

    Toennis, D.; Skamel, H.J. [Institut fuer Strahlendiagnostik, Klinikum Dortmund GmbH (Germany)

    2003-09-01

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.) [German] Fuer die Computertomographie hat sich eine neue Aufgabe ergeben. Es hat sich gezeigt, dass verringerte Pfannenanteversion und Schenkelhalsantetorsion haeufige Ursachen von Hueftschmerz und -arthrose sind, v. a. wenn beide gegen 0 gehen. Da operative Massnahmen vor Eintreten der Arthrose ergriffen werden sollten, sind genaue Messwerte erforderlich. Die Untersuchung sollte in Bauchlage durchgefuehrt werden, um eine einheitliche und weitgehend normale Beckenkippung zu gewaehrleisten. Die Schenkelhalstorsion wird zwischen der Kniegelenk- und der Schenkelhalsachse gemessen. Zur Festlegung der Sagittalebene legt man am besten eine Mittellinie zwischen die Beckenschaufeln. Die Messung der Pfannenanteversion sollte in der Schnitthoehe erfolgen, wo die Bewegungseinschraenkung der Innenrotation auftritt. (orig.)

  16. Hip arthroscopy in the setting of hip dysplasia

    Yeung, M.; Kowalczuk, M.; Simunovic, N.

    2016-01-01

    Objective Hip arthroscopy in the setting of hip dysplasia is controversial in the orthopaedic community, as the outcome literature has been variable and inconclusive. We hypothesise that outcomes of hip arthroscopy may be diminished in the setting of hip dysplasia, but outcomes may be acceptable in milder or borderline cases of hip dysplasia. Methods A systematic search was performed in duplicate for studies investigating the outcome of hip arthroscopy in the setting of hip dysplasia up to July 2015. Study parameters including sample size, definition of dysplasia, outcomes measures, and re-operation rates were obtained. Furthermore, the levels of evidence of studies were collected and quality assessment was performed. Results The systematic review identified 18 studies investigating hip arthroscopy in the setting of hip dysplasia, with 889 included patients. Criteria used by the studies to diagnose hip dysplasia and borderline hip dysplasia included centre edge angle in 72% of studies but the range of angles were quite variable. Although 89% of studies reported improved post-operative outcome scores in the setting of hip dysplasia, revision rates were considerable (14.1%), with 9.6% requiring conversion to total hip arthroplasty. Conclusion The available orthopaedic literature suggests that although improved outcomes are seen in hip arthroscopy in the setting of hip dysplasia, there is a high rate of re-operation and conversion to total hip arthroplasty. Furthermore, the criteria used to define hip dysplasia vary considerably among published studies. Cite this article: M. Yeung, M. Kowalczuk, N. Simunovic, O. R. Ayeni. Hip arthroscopy in the setting of hip dysplasia: A systematic review. Bone Joint Res 2016;5:225–231. DOI: 10.1302/2046-3758.56.2000533. PMID:27313136

  17. Component Alignment in Hip Resurfacing Using Computer Navigation

    Bailey, Chris; Gul, Rehan; Falworth, Mark; Zadow, Steven; Oakeshott, Roger

    2008-01-01

    The use of computer navigation during hip resurfacing has been proposed to reduce the risk of a malaligned component and notching with subsequent postoperative femoral neck fracture. Femoral component malalignment and notching have been identified as the major factors associated with femoral neck fracture after hip resurfacing. We performed 37 hip resurfacing procedures using an imageless computer navigation system. Preoperatively, we generated a patient-specific computer model of the proxima...

  18. MR findings associated with positive distraction of the hip joint achieved by axial traction

    Suter, Aline; Dietrich, Tobias J.; Maier, Matthias; Pfirrmann, Christian W.A. [Radiology, Orthopedic University Hospital Balgrist, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland); Dora, Claudio [Orthopedic University Hospital Balgrist, Orthopedic Surgery, Zurich (Switzerland); University of Zurich, Faculty of Medicine, Zurich (Switzerland)

    2015-06-01

    To determine which MR-arthrography findings are associated with positive hip joint distraction. One hundred patients with MR arthrography of the hip using axial traction were included. Traction was applied during the MR examination with an 8 kg (females) or 10 kg (males) water bag, attached to the ankle over a deflection pulley. Fifty patients showing joint space distraction were compared to an age- and gender-matched control group of 50 patients that did not show a joint distraction under axial traction. Two radiologists assessed the neck-shaft angle, lateral and anterior center-edge (CE) angles, CE angles in the transverse plane, extrusion index of the femoral head, acetabular depth, alpha angle, acetabular version, ligamentum teres, joint capsule and ligaments, iliopsoas tendon and the labrum. Mean joint space distraction in the study group was 0.9 ± 0.6 mm. Patients with positive joint space distraction had significantly higher neck-shaft angles (control group 131.6 ± 5.4 /study group 134.1 ± 6.1 , p < 0.05), smaller lateral CE angles (38.1 ± 5.9 /34.6 ± 7.2 , p < 0.05), smaller overall transverse CE angles (161.4 ± 9.9 /153.6 ± 9.6 , p < 0.001), smaller acetabular depth (4.1 ± 2.4 mm/5.8 ± 2.5 mm, p < 0.01), higher alpha angles (53.5 ± 7.8 /59.2 ± 10.1 , p < 0.01) and a thicker ligamentum teres (4.7 ± 1.4 mm/5.4 ± 1.8 mm, p < 0.05). The other parameters revealed no significant differences. ICC values for interobserver agreement were 0.71-0.95 and kappa values 0.43-0.92. Increased neck-shaft angles, small CE angles, small acetabular depth, higher alpha angles and a thick ligamentum teres are associated with positive joint distraction. (orig.)

  19. MR findings associated with positive distraction of the hip joint achieved by axial traction

    To determine which MR-arthrography findings are associated with positive hip joint distraction. One hundred patients with MR arthrography of the hip using axial traction were included. Traction was applied during the MR examination with an 8 kg (females) or 10 kg (males) water bag, attached to the ankle over a deflection pulley. Fifty patients showing joint space distraction were compared to an age- and gender-matched control group of 50 patients that did not show a joint distraction under axial traction. Two radiologists assessed the neck-shaft angle, lateral and anterior center-edge (CE) angles, CE angles in the transverse plane, extrusion index of the femoral head, acetabular depth, alpha angle, acetabular version, ligamentum teres, joint capsule and ligaments, iliopsoas tendon and the labrum. Mean joint space distraction in the study group was 0.9 ± 0.6 mm. Patients with positive joint space distraction had significantly higher neck-shaft angles (control group 131.6 ± 5.4 /study group 134.1 ± 6.1 , p < 0.05), smaller lateral CE angles (38.1 ± 5.9 /34.6 ± 7.2 , p < 0.05), smaller overall transverse CE angles (161.4 ± 9.9 /153.6 ± 9.6 , p < 0.001), smaller acetabular depth (4.1 ± 2.4 mm/5.8 ± 2.5 mm, p < 0.01), higher alpha angles (53.5 ± 7.8 /59.2 ± 10.1 , p < 0.01) and a thicker ligamentum teres (4.7 ± 1.4 mm/5.4 ± 1.8 mm, p < 0.05). The other parameters revealed no significant differences. ICC values for interobserver agreement were 0.71-0.95 and kappa values 0.43-0.92. Increased neck-shaft angles, small CE angles, small acetabular depth, higher alpha angles and a thick ligamentum teres are associated with positive joint distraction. (orig.)

  20. Imaging of hip arthroplasty

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.)

  1. Treatment of hip dysplasia.

    Anderson, A

    2011-04-01

    Hip dysplasia is a common orthopaedic developmental disorder of dogs. This paper reviews the treatment options available for management of the condition in the skeletally immature and adult dog. PMID:21906059

  2. Taper Hip Prosthesis

    Full Text Available Zimmer M/L Taper Hip Prosthesis with Modular Neck Kinectiv® Technology March 12, 2009 7:00 PM EDT Welcome to this "OR Live" Webcast presentation brought to you by Zimmer. During ...

  3. Hip flexor strain - aftercare

    ... such as sprinting, kicking, and changing direction while running or moving, can stretch and tear the hip flexors. Runners, people who do martial arts, and football, soccer, and hockey players are more likely to have ...

  4. HIP osteoarthritis and work.

    Harris, E Clare; Coggon, David

    2015-06-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment. PMID:26612242

  5. Hip fracture surgeries

    ... nih.gov/pubmed/20837683 . Weinlein JC. Fractures and dislocations of the hip. In: Canale ST, Beaty JH, eds. Campbell's Operative ... Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  6. Hip joint replacement

    ... may have problems with infection, loosening, or even dislocation of the new hip joint. Over time the artificial ... Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, ...

  7. The Immediate Intramedullary Nailing Surgery Increased the Mitochondrial DNA Release That Aggravated Systemic Inflammatory Response and Lung Injury Induced by Elderly Hip Fracture

    Li Gan; Jianfeng Zhong; Ruhui Zhang; Tiansheng Sun; Qi Li; Xiaobin Chen; Jianzheng Zhang

    2015-01-01

    Conventional concept suggests that immediate surgery is the optimal choice for elderly hip fracture patients; however, few studies focus on the adverse effect of immediate surgery. This study aims to examine the adverse effect of immediate surgery, as well as to explore the meaning of mtDNA release after trauma. In the experiment, elderly rats, respectively, received hip fracture operations or hip fracture plus intramedullary nail surgery. After fracture operations, the serum mtDNA levels as ...

  8. 螺旋臼全髋关节置换术治疗发育性髋关节发育不良%Developmental hip dysplasia treated with total hip arthroplasty with threaded cup

    魏威; 寇伯龙; 王小梅; 吕厚山

    2008-01-01

    目的 探讨使用螺旋臼假体治疗发育性髋关节发育不良 (DDH) 继发骨性关节炎患者的临床疗效.方法 自2003年5月至2007年12月,使用Zweymüller螺旋臼假体治疗40例(43髋)DDH继发骨性关节炎患者,其中男6例(6髋),女34例(37髋),平均年龄47.6岁(22~70岁);单侧37例,双侧3例;Crowe分型:Ⅰ级6例,Ⅱ级24例,Ⅲ级10例,Ⅳ级3例.平均随访24.6个月,术前Harris评分最高61分,最低22分,平均43.5分.结果 所有患者术后疼痛基本消失,双下肢长度差异平均1.2 cm,2例术后出现股神经损伤症状,术后6个月症状基本消失,Harris评分最高97分,最低62分,平均85.3分.结论 使用Zweymüller螺旋臼假体治疗DDH继发骨性关节炎的患者,可以达到良好的恢复关节功能的临床疗效,手术不需大块植骨和骨水泥,初期临床效果满意.%Objective The objective of this study was to determine the outcome of total hip arthroplasty with a cementless threaded cup (Zweymuller-SL system) in patients with osteoarthritis secondary to developmental dysplasia of hip (DDH). Methods From May 2003 to December 2007, forty patients (43 hips) with developmental hip dysplasia who were treated with cementless total hip arthroplasty were followed up.The acetabular reconstruction was done with a cementless threaded cup.Among 40 patients, 6 were male, 34 were female and an average age was 47.6 years (range, 22~70 years).37 cases were unilateral DDH and 3 cases were bilateral.According to Crower′s classification, 6 were class Ⅰ, 24 caseswere class Ⅱ, 10 cases were class Ⅲ and 3 cases were class Ⅳ.The meaning following-up period was 24.6 months(range, 4~58 months).The mean preoperative Harris score was 43.5 points (range, 22~61 points).Results The pain of all patients was completely relieved.The postoperative difference of the two leg length reduced to average 1.2 cm.Sciatic palsy happened in 2 patients, but both recovered after 6 months postoperatively

  9. Progression of hip dysplasia in 40 police working dogs: a retrospective study

    The aim of the study was to evaluate the effects of progression of CHD and degenerative joint disease on a working capability of population of police working dogs. In the first part of the study, we reviewed the whole health documentation of all dogs and gathered all necessary radiographs of hip joints that were taken at first initial procurement. In the second part, clinical examination and radiographs of all dogs were taken 60 months after first examination and the progression of hip dysplasia was evaluated by the FCI scheme. All dogs were male, 35 German shepherds and 5 Rottweilers. The Norberg-Olsson angle in the first set of radiographs was 105.54 +/- 3.22 deg in 37 dogs without hip dysplasia and 100.17 +/- 2.99 deg in 3 dogs with initial mild dysplasia. In the second set of radiographs taken after 60 months of service the Norberg- Olsson angle was 105.60 +/- 3.67 deg in 23 dogs with no signs of hip dysplasia and 101.62 +/- 4.49 deg in 17 dogs with hip dysplasia. On the first set of radiographs, secondary degenerative changes were found in 3 dogs with initial mild dysplasia (7.5 %) and in 14 dogs (35 %) on second radiographs. The position of the centre of the femoral head on first radiographs was outside of dorsal acetabular rim in 25 (31.25 %) of estimated hip joints (n = 80); at the level of the rim in 30 (37.5 %) and inside in 25 (31.25 %). On second radiographs it was outside in 41 (51.25 %); at the level of the rim in 26 (32.5 %); and inside in 13 (31.25 %) of estimated hip joints. The mean femoral angle of inclination for all 40 dogs was 132.50 +/- 4.39? deg . If it has occured, the increase in degree of hip dysplasia was generally more than one degree. In 57.5 % of cases hip dysplasia was not determined on second radiographs. All dogs with some degree of hip dysplasia were German shepherds, but only one of them had clinical symptoms connected to CHD. The progression of hip dysplasia did not correlate with work period of the dogs, and has no influence on

  10. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    Yamamoto, Takuaki; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Fukuoka (Japan); Schneider, Robert [Hospital for Special Surgery, Department of Radiology, New York (United States); Bullough, Peter G. [Hospital for Special Surgery, Department of Laboratory Medicine, New York, NY (United States)

    2010-02-15

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  11. Bilateral rapidly destructive arthrosis of the hip joint resulting from subchondral fracture with superimposed secondary osteonecrosis

    A 57-year-old woman suffered rapid destruction of both hip joints over a 10 months period. At the first visit, her radiographs demonstrated slight joint space narrowing and acetabular cyst formation in both hips. Five months later, joint space narrowing had further progressed, and intra-articular injection of steroid was given in both hips. However, the hip pain gradually became worse. Five months later, both joint spaces had totally disappeared and both femoral heads had undergone massive collapse. At gross examination, both resected femoral heads showed extensive opaque yellow areas consistent with osteonecrosis. Microscopic examination of these areas revealed evidence of both extensive fracture and callus formation, as well as necrosis throughout, indicating that the osteonecrosis observed in this case was a secondary phenomenon superimposed on pre-existing osteoarthritis and subchondral fracture. There were many pseudogranulomatous lesions in the marrow space and necrotic area, where tiny fragments of bone and articular cartilage, surrounded by histiocytes and giant cells, were embedded, such as are typically seen in rapidly destructive arthrosis. No radiologic or morphologic evidence of primary osteonecrosis was noted. This case indicates that at least some cases of rapidly destructive arthritis are the result of subchondral fracture with superimposed secondary osteonecrosis. (orig.)

  12. Irreducible traumatic posterior hip dislocation with entrapment and a buttonhole effect

    Uzel Andre Pierre

    2012-02-01

    Full Text Available 【Abstract】The authors reported the case of a 27-year-old man who sustained an irreducible postero-lateral traumatic dislocation of the hip with capsular and labral entrapment. Initial X-rays showed only a small acetabular fragment. After two attempts to reduce the hip with muscle paralysis under general anaesthesia failed, the patient was treated by immediate open reduction through a postero-lateral approach. Surgical exploration of the hip revealed a small osteochondral fragment attached to a large piece of labrum and capsule, clogging the acetabulum. The femoral head crossed over the torn capsule with a buttonhole effect. These elements were relieved, the bone fragment was fixed with a 2 mm screw and the capsule was repaired. At the 10-year follow-up, the functional outcome was excellent with a Harris score of 100 points and no signs of necrosis or osteoarthritis. The authors propose a literature review of this uncommon lesion. Key words: Hip dislocation; Tears; Acetabulum; Necrosis

  13. Visual intraoperative estimation of cup and stem position is not reliable in minimally invasive hip arthroplasty.

    Woerner, Michael; Sendtner, Ernst; Springorum, Robert; Craiovan, Benjamin; Worlicek, Michael; Renkawitz, Tobias; Grifka, Joachim; Weber, Markus

    2016-06-01

    Background and purpose - In hip arthroplasty, acetabular inclination and anteversion-and also femoral stem torsion-are generally assessed by eye intraoperatively. We assessed whether visual estimation of cup and stem position is reliable. Patients and methods - In the course of a subgroup analysis of a prospective clinical trial, 65 patients underwent cementless hip arthroplasty using a minimally invasive anterolateral approach in lateral decubitus position. Altogether, 4 experienced surgeons assessed cup position intraoperatively according to the operative definition by Murray in the anterior pelvic plane and stem torsion in relation to the femoral condylar plane. Inclination, anteversion, and stem torsion were measured blind postoperatively on 3D-CT and compared to intraoperative results. Results - The mean difference between the 3D-CT results and intraoperative estimations by eye was -4.9° (-18 to 8.7) for inclination, 9.7° (-16 to 41) for anteversion, and -7.3° (-34 to 15) for stem torsion. We found an overestimation of > 5° for cup inclination in 32 hips, an overestimation of > 5° for stem torsion in 40 hips, and an underestimation fluoroscopy, or imageless navigation is recommended for correct implant insertion. PMID:26848628

  14. HIP osteoarthritis and work

    Harris, E C; Coggon, D.

    2015-01-01

    Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where...

  15. Percutaneous screw placement in acetabular posterior column surgery: gender differences in implant positioning.

    Dienstknecht, Thomas; Müller, Michael; Sellei, Richard; Nerlich, Michael; Pfeifer, Christian; Krutsch, Werner; Fuechtmeier, Bernd; Berner, Arne

    2014-04-01

    Percutaneous reduction and periarticular screw implantation techniques have been successfully introduced in acetabular surgery. Image guided navigation techniques might be beneficial in increasing accuracy. However, a thorough understanding of standard values is needed to oversee pitfalls. This cadaver study was designed to identify reliable angulation values for screw implantation in the posterior acetabular column and to provide knowledge of the bony thickness for the periarticular corridor. Gender differences were specifically addressed. 27 embalmed cadaveric hemipelvic specimens (13 male, 14 female) were used. After soft-tissue removal posterior column acetabular screw placement was conducted by one experienced orthopaedic trauma surgeon under visibility. Radiographic verification of ideal screw placement was followed by radiographic assessment in three standard views and angulation values were assessed. Through bony dissection the maximal periarticular canal width was assessed. Various angulation values with regard to anatomical landmarks could be determined in the anteroposterior radiograph, as well as in the iliac oblique and the obturator oblique view. Gender differences were significant for all reference points with the pubic rami involved. The minimal canal width was 1.1cm in female and 1.6 cm in male specimen. The findings provide standard values for safe passages in percutaneous posterior column acetabular surgery. Gender differences have to be taken in consideration when planning the drill corridor. By adherence to standard values, screw placement can be performed safely. PMID:24182644

  16. Large head metal-on-metal cementless total hip arthroplasty versus 28mm metal-on-polyethylene cementless total hip arthroplasty: design of a randomized controlled trial

    van Raaij Jos JAM; Bos Nanne; Zijlstra Wierd P

    2008-01-01

    Abstract Background Osteoarthritis of the hip is successfully treated by total hip arthroplasty with metal-on-polyethylene articulation. Polyethylene wear debris can however lead to osteolysis, aseptic loosening and failure of the implant. Large head metal-on-metal total hip arthroplasty may overcome polyethylene wear induced prosthetic failure, but can increase systemic cobalt and chromium ion concentrations. The objective of this study is to compare two cementless total hip arthroplasties: ...

  17. Follow up of biocompatibity of new total hip joint endoprosthesis in a canine model

    Ľ. Rehák

    2010-11-01

    Full Text Available Purpose: of this paper was the follow up of biologic compatibility and functional use of new type endoprosthesis in a canine model.Design/methodology/approach: Prospective animal study with evaluation of new type ZRM of titanium alloy cementless total hip replacement (THR in dogs in 2007. We used congruent ceramic head and polyethylene acetabular inlay. That is the gold standard in THR. The methods of X ray imaging evaluation after implantation and overgrowth evaluation were employed. We evaluated loading and use of the leg during walking and running. Total hip joint replacements were implanted in 6 dogs – German Shepards under general anesthesia. The follow up time was 6 months. We compared X ray findings after the operation and after 6 months, wound healing, use of THR during leg loading and biocompatibility of THR in femur and pelvis.Findings: The femoral and acetabular components were anchored using a press-fit technique. We found good biocompatibility in 5 dogs with good loading during walking and running, one complication with femoral fracture and wound abscess. At six months, there was good bony ongrowth of the THR in 5 dogs and small overgrowth on the surface of THR in one dog, deemed as complication. In the same animal, explanation of the THR was performed, due to fracture.Research limitations/implications: This study was not monitored. In the future, we would like to perform a randomized study design with a control group.Practical implications: The new THR developed by authors can restore function in canine model of damaged hip joint. The press fit anchorage of the cup allowed firm adhesion of the cup surface to the pelvic bone and likewise, the femoral component demonstrated firm fixation in the proximal femur.Originality/value: This paper is original by presenting the first results of new THR in canine model. The value of this paper is in laying groundwork for human study in the future.

  18. Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics

    Vazquez, Jorge; Jauregui, José R.; Iserson, Kenneth V.

    2010-01-01

    Background This prospective, randomized double-blind study, conducted over 19 months in a tertiary care ED, sought to determine if a fascia-iliaca regional anesthetic block provides better and safer pain relief than does parenteral analgesia. Aims This study also aimed to determine the effectiveness of parenteral NSAID analgesia for acute hip fractures. Methods Patients >65 years old presenting at an adult ED with acute hip fractures were randomized upon presentation to the ED into two groups (A and B) using numbers generated by the EPI-INFO™ (Atlanta, GA: Centers for Disease Control and Prevention) program. The randomization list was kept by one of the authors who did not interact with the patients. Two groups of patients were to receive either (A) a fascia-iliaca block with bupivacaine and parenteral saline injection, or (B) the same block with saline and an IV NSAID injection. Upon admission to the study, vital signs such as blood pressure, mean blood pressure (MAP), heart rate (HR), respiratory rate (RR) and pain-intensity measurements [using the Visual Analogue Scale (VAS)] were obtained and repeated at 15 min, 2 h and at8 h. The occurrence of complications was registered. Results One hundred seventy-five patients were randomized, and 21 were excluded from participation. The remaining 154 patients were grouped as: group A (n = 62) or group B (n = 92). The mean pain level on admission to the ED for all patients, assessed with the VAS, was 8.21 ± 0.91 (CI 95%: 6.43–9.99); in group A the VAS was 7.6 ± 0.22 and in group B 8.5 ± 0.72 (p = 0.411). At 15-min evaluation, values were: group A 6.24 ± 0.17 and group B 2.9 ± 0.16 (p < 0.001). At the 2-h assessment, values were: group A 1.78 ± 0.11 and group B 2.3 ± 1.16 (p = 0.764). At 8 h the VAS for group A was 2.03 ± 0.12 and for group B 4.4 ± 0.91 (p = 0.083). Conclusion This study demonstrates that: (1) parenteral NSAIDs are very effective as

  19. Acompanhamento a médio prazo da reconstrução acetabular com enxerto ósseo liofilizado bovino e dispositivo de reforço Mid-term follow-up of acetabular reconstruction using bovine freeze-dried bone graft and reinforcement device

    Ricardo Rosito

    2009-07-01

    Full Text Available OBJETIVO: Relatar a capacidade clínica e radiográfica de integração de enxertos ósseos liofilizados bovinos. MÉTODO: Vinte e cinco pacientes foram incluídos. O período médio de acompanhamento foi de oito anos. Os enxertos foram purificados e liofilizados. A análise clínica baseou-se no escore de Merle d'Aubigné e Postel, e critérios de pontuação estabelecidos para a osteointegração radiográfica foram usados para as análises radiográficas. RESULTADOS: Bons resultados clínicos e radiográficos foram observados em 80% e 72% dos casos, respectivamente. CONCLUSÃO: Enxertos liofilizados bovinos podem ser usados com segurança e adequadamente na revisão acetabular da artroplastia total de quadril.OBJECTIVE: To report clinical and radiographic graft incorporation capability of bovine freeze-dried bone grafts. METHODS: Twenty five patients were enrolled. The mean follow-up was eight years. Grafts were purified and freeze-dried. Clinical analysis was based on the score of Merle d'Aubigné and Postel and an established score criteria for radiographic bone incorporation was used for radiographic analyses. RESULTS: Good clinical and radiographic results were found in 80% and 72% of the cases, respectively. CONCLUSION: Bovine freeze-dried grafts can be safely and adequately used in acetabular revision in total hip arthroplasty.

  20. Evolution of Central Nervous System Multidrug-Resistant Mycobacterium tuberculosis and Late Relapse of Cryptic Prosthetic Hip Joint Tuberculosis: Complications during Treatment of Disseminated Isoniazid-Resistant Tuberculosis in an Immunocompromised Host▿

    Upton, Arlo; Woodhouse, Andrew; Vaughan, Ross; Newton, Sandie; Ellis-Pegler, Rod

    2008-01-01

    We report a case of disseminated isoniazid-resistant tuberculosis in an immunocompromised patient with evolution of rifampin (rifampicin) resistance in the central nervous system. This was cured with intraventricular and oral treatment but was followed by a late relapse of the original infection in a prosthetic hip joint. We provide drug levels in cerebrospinal fluid and serum.

  1. Evaluation of a 2D fluoroscopy-based navigation system for insertion of the dynamic hip screw (DHS). An experimental study

    Purpose: Dynamic hip screw (DHS) insertion for the fixation of lateral femoral neck fractures is an accepted surgical treatment method. A computer-assisted planning and navigation system based on 2D fluoroscopy has been developed for guidewire insertion in order to perform screw placement. The image acquisition process was supported by a radiation-saving procedure called 'zero-dose C-arm navigation'. The aim of this study was to evaluate this new system. Materials and Methods: In the context of a sawbone study, we inserted dynamic hip screws. The procedure was performed under navigation control and in the conventional technique in 12 sawbones. Both procedures were performed in an open and closed technique. Results: The computer-assisted technique significantly reduced the number of intraoperative fluoroscopic images (open technique: -8.1 ± 0.5; p < 0.001 - closed technique: -12.3 ± 3.7; p < 0.001) and the number of guidewire passes (open technique: -1.3 ± 1.2; p < 0.05 - closed technique: -1.5 ± 1.2; p < 0,05). There was no difference with respect to precision in both groups. The operation time was significantly longer in the navigation-assisted groups (open technique: + 14.6 ± 5.4 min; p < 0.001 - closed technique: + 13 ± 3 min; p < 0.001). Conclusion: The addition of computer-assisted planning and surgical guidance supported by 'zero-dose C-arm navigation' may be useful for the fixation of lateral femoral neck fractures by the DHS as it reduces the amount of fluoroscopic images and requires fewer drill tracks. Further studies with the goal of reducing the operation time are necessary. (orig.)

  2. Two-dimensional finite element simulation of fracture and fatigue behaviours of alumina microstructures for hip prosthesis

    Kim, Kyungmok; Géringer, Jean; 10.1177/0954411911422843

    2012-01-01

    This paper describes a two-dimensional (2D) finite element simulation for fracture and fatigue behaviours of pure alumina microstructures such as those found at hip prostheses. Finite element models are developed using actual Al2O3 microstructures and a bilinear cohesive zone law. Simulation conditions are similar to those found at a slip zone in a dry contact between a femoral head and an acetabular cup of hip prosthesis. Contact stresses are imposed to generate cracks in the models. Magnitudes of imposed stresses are higher than those found at the microscopic scale. Effects of microstructures and contact stresses are investigated in terms of crack formation. In addition, fatigue behaviour of the microstructure is determined by performing simulations under cyclic loading conditions. It is shown that crack density observed in a microstructure increases with increasing magnitude of applied contact stress. Moreover, crack density increases linearly with respect to the number of fatigue cycles within a given con...

  3. Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study

    Jacobsen, Steffen; Sonne-Holm, Stig; Søballe, K;

    2005-01-01

    Acta Orthop. 2005 Apr;76(2):149-58. Related Articles, Links Hip dysplasia and osteoarthrosis: a survey of 4151 subjects from the Osteoarthrosis Substudy of the Copenhagen City Heart Study. Jacobsen S, Sonne-Holm S, Soballe K, Gebuhr P, Lund B. Department of Orthopaedic Surgery, Copenhagen...... the standing, standardized pelvic radiographs of 1429 men (22-93 years), and 2430 women (22-92 years). RESULTS: The 4 HD discriminators were interrelated. A negligible sex-related difference in acetabular morphology was found, male acetabulae being slightly more dysplastic than female acetabulae....... However, differences between the sexes for right and left CE angles were within 1.0 degree, and within 1.4 degrees for right and left Sharp's angles. There were no cases of hip subluxation (breakage of Shenton's line > or = 5 mm). Average CE angle was 34 degrees in men (SD 7.3 degrees), and 35 degrees in...

  4. Massive failure of TiNbN coating in surface engineered metal-on-metal hip arthroplasty: Retrieval analysis.

    Łapaj, Łukasz; Markuszewski, Jacek; Wendland, Justyna; Mróz, Adrian; Wierusz-Kozłowska, Małgorzata

    2016-07-01

    This article presents examination of a failed total hip replacement with surface engineered metal-on-metal (MoM) articulation. The implant was coated with a thin TiNbN film (Physical Vapor Deposition), and at retrieval 53 months after implantation the coating was abraded on weight-bearing part of the head and acetabular component. Scanning electron microscopy of bearing surfaces demonstrated multifocal crack formation, delamination of small film fragments, and formation of aggregates containing nanometer sized wear debris. We also observed coating damage in third body mechanism. Complex failure mechanism of TiNbN coating demonstrated in this study suggests insufficient bonding strength between the coating and substrate alloy and raise concerns regarding the use of such coatings in total hip arthroplasty with MoM bearing. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 104B: 1043-1049, 2016. PMID:25980456

  5. Salter%u2019s Innominate Osteotomy in the Treatment of Congenital Hip Dislocation

    Eyup Cagatay Zengin

    2014-03-01

    Full Text Available Aim: Developmental displazy of hip is much seenillness which interest orthopaedic surgery in Turkey and around the world. In early times of illness conservative treatment is succesful but late times of illness surgery is necessary. Salter’s innominate osteotomy, since its initial description in 1961, has become a well-established surgical procedure in the treatment of congenital dislocation of the hip.Material and Method: We reviewed 59 patients with 74 congenitally dislocated hips, all managed by open reduction and Salter’s innominate osteotomy. Mean follow-up period was 4,2 years (range, 2 to 7 years; %82,4 of the hips had a excellent clinical result, and %75,7 were excellent radiologically. The patients who underwent Salter’s innominate osteotomy before the age of 3 had beter clinical and radiological results (%90,4 and %82,5, respectively. The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg and femoral neck-shaft angles. No statistical differences were found between these two groups. The Kalamchi-McEwen classification of avascular necrosis. The late radiographic signs of types 2, 3 and 4 avasculer necrosis were seen in %10,8 of this series. Discussion: The results show that Salter’s innominate osteotomy provides good lateral coverage of the femoral head. The results are beter if the operation is performed between the ages 18 months and 3 years.

  6. Characteristics of children with hip displacement in cerebral palsy

    Wagner Philippe

    2007-10-01

    Full Text Available Abstract Background Hip dislocation in children with cerebral palsy (CP is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme. Methods In a total population of children with CP a standardised clinical and radiological follow-up of the hips was carried out as a part of a hip prevention programme. The present study is based on 212 children followed until 9–16 years of age. Results Of the 212 children, 38 (18% developed displacement with Migration Percentage (MP >40% and further 19 (9% MP between 33 and 39%. Mean age at first registration of hip displacement was 4 years, but some hips showed MP > 40% already at two years of age. The passive range of hip motion at the time of first registration of hip displacement did not differ significantly from the findings in hips without displacement. The risk of hip displacement varied according to CP-subtype, from 0% in children with pure ataxia to 79% in children with spastic tetraplegia. The risk of displacement (MP > 40% was directly related to the level of gross motor function, classified according to the gross motor function classification system, GMFCS, from 0% in children in GMFCS level I to 64% in GMFCS level V. Conclusion Hip displacement in CP often occurs already at 2–3 years of age. Range of motion is a poor indicator of hips at risk. Thus early identification and early radiographic examination of children at risk is of great importance. The risk of hip displacement varies according to both CP-subtype and GMFCS. It is sometimes not possible to determine subtype before 4 years of age, and at present several definitions and classification systems are used. GMFCS is valid and reliable from 2 years of age, and it is internationally accepted. We recommend a hip

  7. Long-term results for the uncemented Zweymuller/Alloclassic hip endoprosthesis. A 15-year minimum follow-up of 320 hip operations.

    Suckel, Andreas; Geiger, Friedrich; Kinzl, Lothar; Wulker, Nikolaus; Garbrecht, Manfred

    2009-09-01

    A follow-up study of 15 (15-17) years of 320 consecutive Zweymuller total hip arthroplasties is presented. Age at surgery was 67 (29-99) years. A total of 164 (51.3%) patients had died. Clinical and radiological examinations were available for 97 (30.3%), phone interviews and radiological examinations for 4 (1.3%) hips, and phone follow-ups for 49 (15.3%). There were 6 (1.9%) patients who were lost to follow-up. The Harris Hip Score results in a median value of 88. According to the Kaplan-Meier method, a survival rate of the cup/inlay of 98% (95% confidence interval, 95%-99%) after 17 years was achieved. For the stem/head, the survival rate was 98% (95% confidence interval, 94%-99%). In 95.2% of patients, no operative revision was required. The rate of aseptic loosening was 2% for the acetabular and 1% for the femoral component. PMID:18789635

  8. The application of MR imaging in the detection of hip involvement in patients with ankylosing spondylitis

    Objective: To investigate the changes in hip MR imaging, evaluate the frequency of hip involvement and compare the value of clinical symptoms, radiographs, and MR imaging in the detection of hip involvement in patients with ankylosing spondylitis (AS). Methods: Anteroposterior radiographs of the pelvis, MR imaging of the hip and clinical evaluation were undertaken in 58 patients with definite AS. All patients were followed up 3 years. Annual radiographs and clinical evaluation were carried out. The imaging data were independently assessed by two experienced radiologists who were blinded to patient identity and clinical characteristics. Based on the Bath Ankylosing Spondylitis Radiology Hip Index (BASRI-hip) scoring system, BASRI-hip scores ≥2 were defined as radiological hip involvement. On MR imaging, both acute and chronic inflammatory changes were considered positive signs for hip involvement. Symptomatic hip involvement was defined as current or past pain or limitation of the hip movement. The statistical analysis was performed using the χ2 test for comparison of sensitivity among clinical symptoms, radiographs, and MR imaging in the detection of hip involvement and the Student's t-test for comparison of disease duration between with and without hip involvement. A P value <0.05 was considered to be statistically significant. For interpreting MRI and radiographs, the percentage of agreement between the two assessors and the kappa coefficients were calculated. Results: On MR imaging, positive changes were detected in 86 (74.1%) hips among 116 hips in all 58 patients. Joint effusion was observed in 73 (62.9%) hips; 23 out of 27 patients who underwent fat-saturated contrast-enhanced T1-weighted sequences had abnormal synovial enhancement in bilateral hips. The other abnormal MR findings included subchondral bone marrow edema in 35 (30.2%) hips, enthesitis in 22 (19.0%) hips, fatty accumulation of the bone marrow in 28 (24.1%) hips, bone erosive destruction

  9. Open reduction and internal fixation aided by intraoperative 3-dimensional imaging improved the articular reduction in 72 displaced acetabular fractures

    Eckardt, Henrik; Lind, Dennis; Toendevold, Erik

    2015-01-01

    Background and purpose - During acetabular fracture surgery, the acetabular roof is difficult to visualize with 2-dimensional fluoroscopic views. We assessed whether intraoperative 3-dimensional (3D) imaging can aid the surgeon to achieve better articular reduction and improve implant fixation....... Patients and methods - We operated on 72 acetabular fractures using intraoperative 3D imaging and compared the operative results, duration of surgery, and complications with those for 42 consecutive acetabular fracture operations conducted using conventional fluoroscopic imaging. Postoperative reduction...... was evaluated on reconstructed coronal and sagittal images of the acetabulum. Results - The fracture severity and patient characteristics were similar in the 2 groups. In the 3D group, 46 of 72 patients (0.6) had a perfect result after open reduction and internal fixation, and in the control group, 17...

  10. 复杂性髋臼骨析合并C型骨盆骨折的手术治疗探讨%Complexity of the acetabular fracture merger C pelvic fractures the surgical treatment of the discussion

    田素魁; 邓庭明; 王振强; 蒋华富; 张玉兴; 陈劲松

    2011-01-01

    Objective To study the complexity of the acetabular fracture merger C pelvic fractures the surgical treatment of the method. Methods Through Mar 2002 to Nov 2007 acetabular merger between fracture patients pelvic fractures are classified according to summarize, pelvic fractures Tile classification and the acetabular Judet-Letourol classification, improved 13 cases were complexity acetabular merger fracture C pelvic fractures, all through the positive before the operation after haing electie line, buried in joint incision open reduction steel plate, screw intemal fixation, average follow-up treatment 2.4 (0.5~4 years). Results 13 patients except 1 patient wound postponed to 20 days after the healing (fat lique-faction), the others are primary healing wound patient in 2 cases, the acetabular poor fracture restoration, follow-up of 0.5~4 years, have 1 patient traumatic hip osteoarthritis pain are more frequent, lame, and another in 2 cases only pain symptoms, without a limp, and analgesia symptoms after treatment, 5 patients feeling of the ache, can bear, not influence the work and life, 5 patients feel and no obvious difference between before the injury. Conclusion Positive preoperative preparation, do as early as possible fractures internal fixation (orif is for complex fracture acetabular merger C pelvic fractures the effective treatment means, in surgical approach and operation in the specific strategies should follow the principle of individual.%目的 探讨复杂性髋臼骨折合并C型骨盆骨折的手术治疗方法.方法 通过对2002年3月~2007年11月间髋臼骨折合并骨盆骨折的病人进行分类总结,按照骨盆骨折Tile分类法和髋臼改良Judet-Letourol分类法,共有13例复杂性髋臼骨折合并C型骨盆骨折,都通过积极手术前处埋后,择期行联合切口进行切开复位钢板、螺钉内固定,平均随访治疗2.4年(0.5~4年).结果 13例病人中除1例病人部分伤口延期至术后20天愈合外(脂

  11. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

    Schmaranzer, Florian; Klauser, Andrea; Henninger, Benjamin [Medical University Innsbruck, Department of Radiology, Innsbruck (Austria); Kogler, Michael; Schmaranzer, Ehrenfried [District Hospital St. Johann in Tyrol, Department of Radiology, St. Johann in Tyrol (Austria); Forstner, Thomas [Johannes Keppler University, Department for Applied Systems Research and Statistics, Linz (Austria); Reichkendler, Markus [District Hospital St. Johann in Tyrol, Department of Orthopedic Surgery, St. Johann in Tyrol (Austria)

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. (orig.)

  12. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. (orig.)

  13. Bipolar hip arthroplasty.

    Chang, Qing; Liu, Shubing; Guan, Changyong; Yu, Fangyuan; Wu, Shenguang; Jiang, Changliang

    2011-12-01

    Our aim was to compare hip arthroplasty with internal screw fixation in the repair of intertrochanteric fractures in elderly patients with osteoporosis. Of 112 included patient, 70 (81.81 ± 4.88 years) received hip arthroplasty with a prosthesis specially designed for intertrochanteric fractures, and 42 (83.46 ± 5.11 years) underwent plate-screw fixation. The hip arthroplasty group had significantly longer operation time, intraoperative blood loss, and total volume of blood transfused but had shorter time to beginning weight-bearing (5.94 ± 2.76 vs 23.68 ± 22.01 days) and higher postoperative Harris hip score (91.37 ± 4.80 vs 86.14 ± 5.46). In the arthroplasty group, there were 2 dislocations; and in the plate-screw fixation group, there were 5 internal fixation failures. Hip arthroplasty is preferable to internal fixation in elderly patients (age >80 years) with osteoporosis. PMID:21530148

  14. Massive heterotopic ossification associated with late deficits in posterior wall of acetabulum after failed acetabular fracture operation

    Zhang, Yuntong; Xie, Yang; Xu, Shuogui; Zhang, Chuncai

    2013-01-01

    Background Heterotopic ossification is a common postoperative complication of acetabular fracture. However, functionally significant heterotopic ossification with associated late bone defects in the posterior wall of the acetabulum is rare and challenging to treat. When heterotopic ossification is a late complication of failed acetabular fracture operation, it is disabling and may only be treated by THA. THA is highly susceptible to premature failure in young and active patients and may requi...

  15. Material development in the SI sub 3 N sub 4 system using glass encapsulated Hip'ing

    Corbin, N.D.; Sundberg, G.J.; Siebein, K.N.; Willkens, C.A.; Pujari, V.K.; Rossi, G.A.; Hansen, J.S.; Chang, C.L.; Hammarstrom, J.L.

    1992-04-01

    This report covers a two-year program to develop fully dense Si{sub 3}N{sub 4} matrix SiC whisker composites with enhanced properties over monolithic Si{sub 3}N{sub 4} materials. The primary goal was to develop a composite with a fracture toughness > 10 MPa{radical}m, capable of using high pressure glass encapsulated HIP'ing. Coating methods were developed to apply thin (<150nm) stoichiometric BN layers to SiC whiskers and also to apply a dual coating of SiC over carbon to the whiskers. Fracture toughness of the composites was determined to increase as the quantity of whiskers (or elongated grains) with their axis perpendicular to the crack plane increased. Of the interface compositions evaluated in this effort, carbon was determined to be the most effective for increasing toughness. The highest toughnesses (6.8--7.0 MPa{radical}m) were obtained with uniaxially aligned carbon coated whiskers. There was no evidence of the carbon coating compromising the oxidation resistance of the composites at 1370{degree}C.

  16. X-Ray Exam: Hip

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth X-Ray Exam: Hip KidsHealth > For Parents > X-Ray Exam: Hip Print A A A Text Size ... español Radiografía: cadera What It Is A hip X-ray is a safe and painless test that uses ...

  17. Are morbidly obese patients undergoing total hip arthroplasty at an increased risk for component malpositioning?

    Elson, Leah C; Barr, Christopher J; Chandran, Shaun E; Hansen, Viktor Johannes; Malchau, Henrik; Kwon, Young-Min

    2013-09-01

    Acetabular cup positioning is a critical factor in determining adverse clinical outcomes in THA. This evaluation was performed to determine if morbid obesity (BMI ≥35kg/m(2)) is a contributing risk factor to cup malpositioning. Two groups of patients were obtained from a local arthroplasty registry and match-controlled for gender, age, and diagnosis (n=211 morbidly obese; n=211 normal). Intraoperative data and postoperative AP pelvis and cross-table lateral radiographs were obtained for each patient. The Martell Hip Analysis Suite was used to calculate cup positioning (successful positioning defined as 30°-45° of abduction, and 5°-25° of anteversion), as well as varus-valgus alignment of the femoral stem. There was a significant correlation between morbid obesity with respect to underanteversion; using multivariate analysis, there was a trend toward a combined underanteversion/overabduction of the acetabular cup. Of all variables considered, high BMI was the most significant risk factor leading to malpositioning. PMID:23910510

  18. Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture surgery%股骨干及股骨转子间骨折合并同侧髋臼骨折的手术治疗

    赵阳; 薛朝辉; 杨凯

    2013-01-01

    目的:探讨股骨干及股骨转子间骨折合并同侧髋臼骨折的治疗方法及临床疗效。方法股骨干及股骨转子间骨折合并同侧髋臼骨折10例,均为男性;年龄23~56岁,平均34.5岁。髋臼骨折按Letournel分型,后壁伴后柱骨折6例,单纯后壁骨折2例,髋关节中心性骨折脱位2例。均行重建钢板内固定。股骨骨折行加长髓内钉固定6例;股骨干行钢板内固定,股骨转子间骨折行动力髋螺钉固定4例。结果6例均获随访,随访时间12个月~3年,平均17.2个月。骨折均临床愈合,髋关节功能根据D’Aubigne疗效评定标准:优7例,良2例,可1例。10例中漏诊2例,漏诊率20%。结论股骨干及股骨转子间骨折合并同侧髋臼骨折受伤暴力大、机制复杂漏诊率较高,应早期明确诊断,合理内固定临床疗效尚好。%Objective: Explore the femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture treatment and the clinical efficacy .Methods: Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture 10 cases, men; age 23- 56 years old, average 34.5 years old. Letournel acetabular fractures according to type, the posterior wal with 6 cases of posterior column fracture, 2 cases of posterior wal fractures alone are line Femoral shaft,Central fracture dislocation of the hip in 2 cases; with interlocking intramedul ary nailing Example,6; femur plate fixation line, intertrochanteric fracture of femur with dynamic hip screw fixation Example 4. Results: 10 patients were fol owed up for 12 months to 36 months, an average of 17.2 months. Clinical healing of fractures, hip function according to D’Aubigne efficacy criteria: excellent 7 cases, good in 2 cases, Example 1. Example 10 in two cases of missed diagnosis, missed diagnosis rate of 20%. Conclusion: Femoral shaft and intertrochanteric fracture with ipsilateral acetabular fracture were injured in the violence

  19. 3-year follow-up of a long-term registry-based multicentre study on vitamin E diffused polyethylene in total hip replacement

    Sillesen, Nanna H; Greene, Meridith E; Nebergall, Audrey K;

    2016-01-01

    early adverse events from using this new biomaterial. METHODS: The enrolled patients (n = 977) have received either a porous titanium coated or porous plasma sprayed acetabular shell with either a E-XLPE liner or a medium cross-linked (AXL) liner. At each follow-up 5 patient-reported outcome measures...... (PROMs) were completed: Harris Hip Score, Case Mix Indicator, UCLA Activity Score, SF-36, and EQ-5D. Radiographs were measured for cup and stem position, as well as femoral head penetration into the liner (wear). Postoperative complications and revisions were collected. RESULTS: At 3 years follow...

  20. Adult hip dysplasia and osteoarthritis. Studies in radiology and clinical epidemiology

    Jacobsen, Steffen

    2006-01-01

    Osteoarthritis (OA) presupposes the interaction of systemic and/or local factors. In hip joint OA, congenital or developmental malformation is believed to constitute an individual risk factor for premature degeneration. Hip dysplasia (HD) is such a malformation. The radiological and epidemiological...... to be a significant risk factor for hip OA in men. However, only obesity was found to determine an event of hip replacement surgery. In a longitudinal study of 81 subjects and with mild or moderate hip dysplasia followed for a decade we did not document a tendency for radiological degeneration compared to 136 control...... studies. To develop a comprehensible and reproducible radiographic discriminator of hip OA with as close an association to self reported hip pain as possible. To identify prevalences of hip OA and HD in a Caucasian, urban background population and investigate the influence of sex, age, physical...